Transition experiences and health care utilization among young adults with type 1 diabetes

Abstract

BackgroundThe purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization.MethodsWe developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center.ResultsOf 291 surveys sent, 83 (29%) were undeliverable and three (1%) were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%). Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian) transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2–16.5) or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3–31.5) were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79%) were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5–24.0) compared with those receiving diabetes care from a general internist/adult primary care doctor (17%). Two-thirds (66%) reported receiving all recommended diabetes screening tests in the previous year, with no difference according to provider type.ConclusionIn this sample, transition preparation was variable and one quarter reported gaps in obtaining adult diabetes care. Nevertheless, the majority endorsed currently receiving regular diabetes care, although visit frequency differed by provider type. Because locating patients after transition was incomplete, our findings suggest the need for standardized methods to track transitioning patients.

Type 1 Diabetes in Young Adulthood

“…Increasing young adults’ confidence in their abilities to manage diabetes and gradually shifting responsibility for diabetes management from family-based management to primarily individual management are important considerations when preparing for independent living situations [28, 29]. Living situation may also influence or hasten transition to adult medical care, and young adults must quickly engage in local health services for diabetes care when they move to a new location [30, 31]. …”

“…Med-Peds trained endocrinologists), though the latter is less common [31, 39, 40]. The majority of youth transfer to an adult medical care provider between ages 18–22, with a median age of 19.5 – 20 years [41, 42].…”

“…The majority of youth transfer to an adult medical care provider between ages 18–22, with a median age of 19.5 – 20 years [41, 42]. More than 25% of young adults report a significant gap in medical care (>6 months) during the transition to adult medical care [31, 43]. Gaps in medical care in young adulthood may be related to psychosocial concerns such as stressful life circumstances or competing life priorities, health care system issues such as inadequate health insurance and difficulty getting appointments, or lack of preparation for adult medical care [11, 44].…”

Technology Use in Transition-Age Patients With Type 1 Diabetes

“…2 In the diabetes literature, the transition process has become a focus of considerable research, as health care management during and after the transfer of care tends to be challenging as demonstrated by poorer health outcomes. 3 There is broad consensus that a lack of effective transition from pediatric to adult diabetes care may contribute to fragmentation in health care, decreased frequency of clinical follow-up, and adverse outcomes in young adults with T1D, however empirical data are limited on best practices in the transition process especially within the United States. 4 Another challenge is the variability in age range cited in transition literature.…”

Family Perspectives of Components of a Diabetes Transition Program

“…Unfortunately, inability to take on independent diabetes self-management behaviors can lead to further complications such as poor glycemic control and loss to follow up care (Garvey, Markowitz et al, 2012). In a study conducted by Garvey et al (2013) that examined health care transition experiences of young adults, 26% stated that they were not seen for N 6 months, and 6% waited N 12 months before they saw an adult provider after their last pediatric diabetes visit. Youth with T1DM ages 20-29 are four times more likely to die than their peers without diabetes (Rapley & Davidson, 2010).…”