A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well‐being to their clinical course in young people with Type 1 diabetes mellitus during transition from child to adult health services

Abstract

AimWe hypothesized that participant well‐being and satisfaction with services would be positively associated with a satisfactory clinical course during transition from child to adult health care.MethodsSome 150 young people with Type 1 diabetes mellitus from five diabetes units in England were recruited to a longitudinal study of transition. Each young person was visited at home four times by a research assistant; each visit was 1 year apart. Satisfaction with services (Mind the Gap; MTG) and mental well‐being (Warwick–Edinburgh Mental Well‐being Scale; WEMWBS) were captured. Change in HbA1c, episodes of ketoacidosis, clinic and retinal screening attendance were used to assess clinical course. In total, 108 of 150 (72%) young people had sufficient data for analysis at visit 4.ResultsMean age at entry was 16 years. By visit 4, 81.5% had left paediatric healthcare services. Median HbA1c increased significantly (P = 0.01) from 69 mmol/mol (8.5%) at baseline to 75 mmol/mol (9.0%) at visit 4. WEMWBS scores were comparable with those in the general population at baseline and were stable over the study period. MTG scores were also stable. By visit 4, some 32 individuals had a ‘satisfactory’ and 76 a ‘suboptimal’ clinical course. There were no significant differences in average WEMWBS and MTG scores between the clinical course groups (P = 0.96, 0.52 respectively); nor was there a significant difference in transfer status between the clinical course groups.ConclusionsThe well‐being of young people with diabetes and their satisfaction with transition services are not closely related to their clinical course. Investigating whether innovative psycho‐educational interventions can improve the clinical course is a research priority.

Associations between adolescent experiences, parent experiences and HbA1c: results following two surveys based on the Norwegian Childhood Diabetes Registry (NCDR)

“…No significant associations between the adolescent indicators and HbA1c level were found, in line with previous studies 10–12. However, three of the seven parent indicators were correlated significantly with the adolescent HbA1c levels.…”

“…In the same study adolescents aged >13 years who reported a higher quality of care had lower HbA1c levels 9. However, other studies have not found significant correlations between the satisfaction of young peoples with diabetes care and their HbA1c levels 10–12…”

Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness

“…The prevalence of anxiety and depression is high, and mental health and well-being difficulties are up to four times higher in children with physical health LTCs than in healthy peers (Hysing et al, 2007 ; Pinquart and Shen, 2011a , b ; Ferro, 2016 ; Brady et al, 2017 ). Mental health is a key predictor of a successful clinical course; for example, baseline depression in children with rheumatic diseases was associated with higher levels of pain and disability 4 years later (Colver et al, 2018 ; Gray et al, 2018 ; Hanns et al, 2018 ). Good childhood mental health optimizes engagement in daily activities for children and families; facilitates psychosocial development, educational attainment, and increased life-course opportunity; and protects against adult mental health problems (DoH, 2011 ; Colver et al, 2018 ; Tollisen et al, 2018 ).…”

The added value of transition programs in Dutch diabetes care: A controlled evaluation study

“…Psychosocial issues are common in this phase, and young T1DM patients have signi cantly higher rates of diabetes-related distress than other age groups [7]. These issues could lead to deterioration of glycosylated hemoglobin (HbA1c) levels with an associated increase in acute and even chronic complications such as ketoacidosis or microvascular problems [8][9][10][11].…”

“…It is not feasible to implement all interventions at every center, and generalizability is often limited due to differing study designs and outcome measures [6,19]. As a result, factors that effectively in uence the transition process are still poorly understood [11,[20][21][22][23][24]. Consensus on the de nition of transition success is lacking, and little high-quality evidence on which to base transition practice is available [6,19].…”