Impact of a special therapeutic education programme in patients transferred from a paediatric to an adult diabetes unit

Abstract

The control of type 1 diabetes (T1D) in young subjects is especially troublesome in adolescence. In this period, young T1D subjects are usually transferred to adult diabetes units. Transfer conditions could be a determinant factor to achieve adequate treatment compliance and optimal metabolic control.The aim of this study was to evaluate the impact of a specifically designed transition therapeutic education programme (TEP) on glycaemic control, self-management and quality of life, 12 months after the transfer of young subjects with T1D from a paediatric to an adult diabetes unit.The study included 80 young T1D subjects (aged 19.0±1.3 years, 39 females, T1D duration 7.3±1. In all, 72 out of 80 subjects completed the TEP. We observed an improvement in metabolic control (HbA 1c 8.5±1.7 vs 7.4±1.5, p<0.001) with a decrease in the number of hypoglycaemic episodes (severe: 0.39 vs 0.14 episodes/patient/year, p<0.001; >5 non-severe/weak: 15% vs 0% patients, p<0.005). There were no differences in terms of total daily insulin dose. However, an increase was observed in the proportion of rapid-acting insulin (23% vs 52%, p<0.001). After 12 months of TEP, a higher proportion of subjects were able to perform self-adjustment of insulin doses (13% vs 48%, p<0.001). Likewise, TEP improved their knowledge in T1D management (DKQ2 25/35 vs 29/35, p<0.001) without worsening the quality of life score.In conclusion, the use of a special transition TEP achieves an improvement in metabolic control and self-management abilities without worsening the quality of life of young T1D subjects transferred from a paediatric to an adult diabetes unit.

Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

“…Table 2 summarizes the major intervention studies. 4,[13][14][15][16][17] In essence, interventions aimed at decreasing loss to follow-up achieve this aim. However, no studies show a better outcome in terms of metabolic control, psychosocial adjustment, complication rates, or other metabolic or medical indicators.…”

Transition Care for Children With Special Health Care Needs

“…36,41 The remainder studied a variety of conditions including congenital adrenal hyperplasia, 21 HIV, 24 epilepsy, 25 juvenile idiopathic arthritis, 38 spina bifida, 42 cystic fibrosis, 37 or inflammatory bowel disease 43 or included a patient population comprising .1 chronic disease. 20,35,44 Twelve studies were conducted in Europe: 8 in the United Kingdom, 21,22,29,32,35,36,39,50 1 in Germany, 33 1 in Spain, 40 and 2 in 26 One study included data from the United Kingdom and Australia. 24 Few studies used a concurrent comparison group.…”

“…[27][28][29][30][31][32]39,40 Interventions included use of a transition coordinator (n = 2), 27,29 attendance of the pediatrician at the adult care visit(s) (n = 2), 27,31 education and skill building (n = 3), 28,39,40 a specialized young adult clinic (n = 4), 28,29,32,39 and use of technology for education and reminders (n = 2). 29,30 In 5 models, patients transferred directly into an adult clinic.…”

“…29,30 In 5 models, patients transferred directly into an adult clinic. 27,[30][31][32]40 Two programs used practical assistance with scheduling. 29,40 No 2 studies evaluated the same transition intervention, although some intervention components were common across studies.…”

“…27,[30][31][32] Seven studies used HbA1c levels as outcomes. [27][28][29]31,32,39,40 Patient satisfaction was the focus of 2 studies. 27,31 Five studies included some sort of comparison group, 27,28,30,32,39 with 3 using concurrent comparators, 27,28,32 although the analyses were retrospective.…”