Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY.
Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, NY.
Diabetes Care. 2024 Nov 1;47(11):1995-2001. doi: 10.2337/dc24-1346.
Underserved young adults (YA) with type 1 diabetes (T1D) experience the worst outcomes across the life span. We developed and integrated the Supporting Emerging Adults with Diabetes (SEAD) program into routine endocrinology care to address unmet social and medical challenges.
This study was designed as a longitudinal cohort study, with prospective data collection over 4 years on YA in SEAD compared with usual endocrine care. We used propensity-weighted analysis to account for differences in baseline characteristics, and multivariate regression and Cox proportional hazard models to evaluate change in outcomes over time. Primary outcomes included incidence of hospitalizations, diabetes technology uptake, and annual change in HbA1c levels.
We included 497 YA with T1D in SEAD (n = 332) and usual endocrine care (n = 165); mean age 25 years, 27% non-Hispanic Black, 46% Hispanic, 49% public insurance, mean HbA1c 9.2%. Comparing YA in SEAD versus usual care, 1) incidence of hospitalizations was reduced by 64% for baseline HbA1c >9% (HR 0.36 [0.13, 0.98]) and 74% for publicly insured (HR 0.26 [0.07, 0.90]); 2) automated insulin delivery uptake was 1.5-times higher (HR 1.51 [0.83, 2.77]); and 3) HbA1c improvement was greater (SEAD, -0.37% per year [-0.59, -0.15]; usual care, -0.26% per year [-0.58, 0.05]).
SEAD meaningfully improves clinical outcomes in underserved YA with T1D, especially for publicly insured and high baseline HbA1c levels. Early intervention for at-risk YA with T1D as they enter adult care could reduce inequity in short and long-term outcomes.
患有 1 型糖尿病（T1D）的服务不足的年轻成年人（YA）在整个生命周期中经历着最糟糕的结果。我们开发并整合了支持有糖尿病的新兴成年人（SEAD）计划，以解决未满足的社会和医疗挑战，将其纳入常规内分泌学护理中。
这项研究设计为纵向队列研究，对 SEAD 中的 YA 进行了为期 4 年的前瞻性数据收集，与常规内分泌护理进行比较。我们使用倾向评分加权分析来解释基线特征的差异，并使用多元回归和 Cox 比例风险模型来评估随时间变化的结果。主要结果包括住院发生率、糖尿病技术采用率和 HbA1c 水平的年变化。
我们纳入了 SEAD（n = 332）和常规内分泌护理（n = 165）中 497 名患有 T1D 的 YA；平均年龄 25 岁，27%为非西班牙裔黑人，46%为西班牙裔，49%为公共保险，平均 HbA1c 为 9.2%。与 SEAD 中的 YA 相比，常规内分泌护理：1）对于基线 HbA1c >9%的患者，住院发生率降低了 64%（HR 0.36 [0.13, 0.98]），对于公共保险患者降低了 74%（HR 0.26 [0.07, 0.90]）；2）自动胰岛素输送采用率提高了 1.5 倍（HR 1.51 [0.83, 2.77]）；3）HbA1c 改善更大（SEAD，每年降低 0.37% [-0.59, -0.15]；常规护理，每年降低 0.26% [-0.58, 0.05]）。
SEAD 显著改善了患有 T1D 的服务不足的 YA 的临床结果，特别是对于公共保险和高基线 HbA1c 水平的患者。对患有 T1D 的高危 YA 进行早期干预，当他们进入成人护理时，可以减少短期和长期结果的不平等。
