Paediatric-to-adult transition in type 1 diabetes: A two-centre experience of a structured program, 2014 to 2022.

BACKGROUND

Transition from paediatric to adult healthcare is a turning point for patients with Type 1 diabetes (T1D). A gradual coordinated process connecting paediatric and adult healthcare providers may improve adherence to adult follow-up.

AIMS

To describe a transition process developed jointly by paediatric and adult diabetology units and compare patients progressing or not to follow-up in adult care setting.

MATERIEL AND METHODS

Retrospective study in one paediatric and one adult diabetology department. Patients following from 2014 to 2021 in the paediatric department were eligible.

RESULTS

At transition, the 183 patients included had a median age of 19 [18.5-19.5] years, T1D duration of 10.5 [7.0-14.0] years, and HbA1c of 8.4% [7.5-9.2%]; 30.6% were treated by continuous subcutaneous insulin infusion. Two years after exiting paediatric care, the subgroup transitioning to adult care at the planned site (n = 137) had a median HbA1c of 7.8% [7.0-8.7]; 13.1% had retinopathy (non-significant change), and 10.8% had changed their insulin treatment. Of the remaining 46/183 (25.1%) patients, 33/46 (71.7%) had no adult care visits at any site reported. Independent predictors of non-adherence to adult follow-up were younger age at TID diagnosis (adjusted odds ratio, 0.91 [0.83-0.99]) and higher pre-transition HbA1c (+1.39 [1.11-1.80]). Among the 52 (28.4%) patients who completed a questionnaire on perceptions, 88.5% reported being well prepared and 90.5% a neutral or positive impact on their diabetes.

CONCLUSION

With a gradual coordinated transition process, most T1D patients attended adult care follow-up visits. Younger age at diagnosis and worse glycaemic control were associated with lack of adherence to planned adult care follow-up.