Shulman Rayzel, Zenlea Ian, Ivers Noah, Austin Peter C, Li Ping, Clarson Cheril, Landry Alanna, Harrington Jennifer, Mukerji Geetha, Palmert Mark R, Parsons Janet, Punthakee Zubin, Shah Baiju R
Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Diabet Med. 2025 Jan;42(1):e15444. doi: 10.1111/dme.15444. Epub 2024 Oct 29.
To test whether an audit and feedback-based intervention improved HbA1c 12 months after transfer to type 1 diabetes adult care.
Multi-centre, quasi-experimental pre-post study of an AF-based intervention targeting paediatric diabetes teams, which encouraged the implementation of an evidence-informed structured transition process at five paediatric diabetes centres in Ontario, Canada. Participants entered the study at their final paediatric visit. A parallel control cohort was ascertained using population-based administrative datasets. The primary outcome was HbA1c 12 months after transfer. The main exposure was the study period: pre-implementation (June 2018-May 2019); early-implementation (June 2019-September 2020); and late-implementation (October 2020-September 2021). Multivariable linear regression models were fit separately in each cohort.
There were 449 and 2844 individuals in the intervention and control cohorts, respectively. Twelve months after transfer, participants in the late-implementation intervention cohort had an HbA1c that was, on average, 0.41% lower than participants in the pre-implementation period (p = 0.016). Among the control cohort, there was no significant difference in the HbA1c 12 months after transfer between study periods.
We found an effect of the intervention on glycaemic management one year following transfer to adult care. Future work will focus on refining and testing the effectiveness of the intervention in an expanded number of study sites and in collaboration with adult diabetes care providers.
测试基于审核与反馈的干预措施在转至成人1型糖尿病护理12个月后是否能改善糖化血红蛋白（HbA1c）水平。
针对儿科糖尿病团队开展的基于审核与反馈（AF）干预措施的多中心、准实验性前后对照研究，该干预措施鼓励加拿大安大略省的五个儿科糖尿病中心实施基于证据的结构化过渡流程。参与者在其最后一次儿科就诊时进入研究。使用基于人群的行政数据集确定了一个平行对照队列。主要结局是转至成人护理12个月后的糖化血红蛋白（HbA1c）水平。主要暴露因素是研究阶段：实施前（2018年6月至2019年5月）；早期实施阶段（2019年6月至2020年9月）；以及后期实施阶段（2020年10月至2021年9月）。在每个队列中分别拟合多变量线性回归模型。
干预队列和对照队列分别有449人和2844人。转至成人护理12个月后，后期实施干预队列的参与者糖化血红蛋白（HbA1c）水平平均比实施前期的参与者低0.41%（p = 0.016）。在对照队列中，不同研究阶段转至成人护理12个月后的糖化血红蛋白（HbA1c）水平无显著差异。
我们发现该干预措施在转至成人护理一年后对血糖管理有效果。未来的工作将集中在扩大研究地点数量并与成人糖尿病护理提供者合作，以完善和测试该干预措施的有效性。
