Skip to main content

Advertisement

SpringerLink
Log in

Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Background

Emerging adulthood is a challenging period for diabetes management. Our aim was to determine whether a dedicated transition clinic for emerging adults with type 1 diabetes can improve glycemic control and visit attendance.

Methods

An observational study of 53 emerging adults (30 males) treated during 2010–2014 in a newly established transition clinic. The clinic was operated jointly by pediatric and adult endocrinologists and included a transition coordinator. Data collected included the source of referral, HbA1c levels, frequency of visit attendance, and acute complications. For 27 patients who had attended the pediatric clinic at the same medical center, data from up to 2 years preceding the transition were also collected. Patients filled the Diabetes Quality of Life–Youth questionnaire at the transition and 1 year later.

Results

Mean ± SD age at the transfer to the transition clinic was 22.1 ± 2.7 years; mean disease duration was 8.4 ± 5.0 years. Follow-up duration at the transition clinic was 1.2 ± 1.1 years. Mean HbA1c levels decreased from 67 mmol/mol (95 % CI 63–72) [8.3 % (95 % CI 7.9–8.7)] at transfer to 57 mmol/mol (95 % CI 52–63) [7.4 % (95 % CI 6.9–7.9)] after 1 year (p < 0.001). Thirty-six patients (68 %) attended three or more visits during their first year in the transition clinic. The impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly during 1-year attendance in the transition clinic.

Conclusions

A dedicated transition clinic for emerging adults, with tailored support according to the developmental needs of emerging adulthood, showed improved glycemic control and visit attendance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

T1DM:

Type 1 diabetes mellitus

MDI:

Multiple daily injection

CGM:

Continuous glucose monitoring

BMI:

Body mass index

DKA:

Diabetic ketoacidosis

CI:

Confidence intervals

References

  1. Epstein RA, McPheeters ML (2014) Transition care for children with special health care needs. Pediatrics 134(5):900–908

    Article  PubMed Central  PubMed  Google Scholar 

  2. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, Transitions Clinical Report Authoring Group, Cooley WC, Sagerman PJ (2011) Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics 128(1):182–200

    Article  Google Scholar 

  3. Arnett JJ (2000) Emerging adulthood: a theory of development from the late teens through the twenties. Am Psychol 55(5):469–480

    Article  PubMed  CAS  Google Scholar 

  4. Peters A, Laffel L, American Diabetes Association Transitions Working Goup (2011) Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care 34(11):2477–2485

    Article  PubMed Central  PubMed  Google Scholar 

  5. Allen D, Gregory J (2009) The transition from children’s to adult diabetes services: understanding the ‘problem’. Diabet Med 26(2):162–166

    Article  PubMed  CAS  Google Scholar 

  6. Sheehan AM, While AE, Coyne I (2014) The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: a systematic review. Diabet Med

  7. Lotstein DS, Seid M, Klingensmith G, Case D, Lawrence JM, Pihoker C et al (2013) Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence. Pediatrics 131(4):e1062–e1070

    Article  PubMed Central  PubMed  Google Scholar 

  8. Lyons SK, Becker DJ, Helgeson VS (2014) Transfer from pediatric to adult health care. Effects on diabetes outcomes. Pediatr Diabetes 15(1):10–17

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lyons SK, Libman IM, Sperling MA (2013) Clinical review: diabetes in the adolescent. Transitional issues. J Clin Endocrinol Metab 98(12):4639–4645

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  10. Garvey KC, Wolpert HA, Rhodes ET, Laffel LM, Kleinman K, Beste MG et al (2012) Health care transition in patients with type 1 diabetes: young adult experiences and relationship to glycemic control. Diabetes Care 35(8):1716–1722

    Article  PubMed Central  PubMed  Google Scholar 

  11. Northam EA, Lin A, Finch S, Werther GA, Cameron FJ (2010) Psychosocial well-being and functional outcomes in youth with type 1 diabetes 12 years after disease onset. Diabetes Care 33(7):1430–1437

    Article  PubMed Central  PubMed  Google Scholar 

  12. Chiang JL, Kirkman MS, Laffel LM, Peters AL (2014) Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care 37(7):2034–2054

    Article  PubMed  Google Scholar 

  13. Ingersoll GM, Marrero DG (1991) A modified quality-of-life measure for youths: psychometric properties. Diabetes Educ 17(2):114–118

    Article  PubMed  CAS  Google Scholar 

  14. (1996) Influence of intensive diabetes treatment on quality-of-life outcomes in the diabetes control and complications trial. Diabetes Care 19(3):195–203

  15. Kipps S, Bahu T, Ong K, Ackland FM, Brown RS, Fox CT et al (2002) Current methods of transfer of young people with Type 1 diabetes to adult services. Diabet Med 19(8):649–654

    Article  PubMed  CAS  Google Scholar 

  16. Holmes-Walker DJ, Llewellyn AC, Farrell K (2007) A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with Type 1 diabetes aged 15–25 years. Diabet Med 24(7):764–769

    Article  PubMed  CAS  Google Scholar 

  17. Cadario F, Prodam F, Bellone S, Trada M, Binotti M, Trada M et al (2009) Transition process of patients with type 1 diabetes (T1DM) from paediatric to the adult health care service: a hospital-based approach. Clin Endocrinol 71(3):346–350

    Article  CAS  Google Scholar 

  18. Insabella G, Grey M, Knafl G, Tamborlane W (2007) The transition to young adulthood in youth with type 1 diabetes on intensive treatment. Pediatr Diabetes 8(4):228–234

    Article  PubMed  Google Scholar 

  19. Fullerton B, Jeitler K, Seitz M, Horvath K, Berghold A, Siebenhofer A (2014) Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus. Cochrane Database Syst Rev 2:CD009122

  20. Vanelli M, Caronna S, Adinolfi B, Chiari G, Gugliotta M, Arsenio L (2014) Effectiveness of an uninterrupted procedure to transfer adolescents with Type 1 diabetes from the Paediatric to the Adult Clinic held in the same hospital: eight-year experience with the Parma protocol. Diabetes Nutr Metab 17(5):304–308

    Google Scholar 

  21. Sparud-Lundin C, Ohrn I, Danielson E, Forsander G (2008) Glycaemic control and diabetes care utilization in young adults with Type 1 diabetes. Diabet Med 25(8):968–973

    Article  PubMed  CAS  Google Scholar 

  22. Neu A, Losch-Binder M, Ehehalt S, Schweizer R, Hub R, Serra E (2010) Follow-up of adolescents with diabetes after transition from paediatric to adult care: results of a 10-year prospective study. Exp Clin Endocrinol Diabetes 118(6):353–355

    Article  PubMed  CAS  Google Scholar 

  23. Johnston PBP, Tennet H, Carson D (2006) Audit of young people with type 1 diabetes transferring from paediatric to adult diabetic services. Pract Diabetes Int 23:106–108

    Article  Google Scholar 

  24. Helgeson VS, Reynolds KA, Snyder PR, Palladino DK, Becker DJ, Siminerio L et al (2013) Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes. Diabet Med 30(5):610–615

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  25. Pyatak EA, Sequeira PA, Whittemore R, Vigen CP, Peters AL, Weigensberg MJ (2014) Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with Type 1 diabetes. Diabet Med

  26. Annunziato RA, Baisley MC, Arrato N, Barton C, Henderling F, Arnon R, Kerkar N (2013) Strangers headed to a strange land? A pilot study of using a transition coordinator to improve transfer from pediatric to adult services. J Pediatr 163(6):1628–1633

    Article  PubMed  Google Scholar 

  27. Hynes L, Byrne M, Dinneen SF, McGuire BE, O’Donnell M, McSharry J (2014) Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15–30 years) with type 1 diabetes mellitus: a systematic review. Pediatr Diabetes. doi:10.1111/pedi.12198

    PubMed  Google Scholar 

  28. Nakhla M, Daneman D, To T, Paradis G, Guttmann A (2009) Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System. Pediatrics 124(6):e1134–e1141

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Mrs. Cindy Cohen for her editorial assistance.

Conflict of interest

The authors declare no conflicts of interest.

Ethical standard

The study was approved by the Institutional Review Board at the Sheba Medical Center.

Human and animal rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed consent disclosure

Due to the retrospective nature of the analysis, informed consent was not obtained with approval of the Institutional Review Board.

Author information

Authors and Affiliations

  1. Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel

    Y. Levy-Shraga, N. Elisha, M. Ben-Ami & O. Pinhas-Hamiel

  2. Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Y. Levy-Shraga, N. Elisha, M. Ben-Ami, L. Lerner-Geva, O. Cohen & O. Pinhas-Hamiel

  3. The Women and Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel

    V. Boyko & L. Lerner-Geva

  4. Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel

    T. Ziv, N. Konvalina & O. Cohen

Authors
  1. Y. Levy-Shraga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Elisha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Ben-Ami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Boyko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Lerner-Geva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Ziv
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. N. Konvalina
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. O. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. O. Pinhas-Hamiel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Levy-Shraga.

Additional information

Managed by Massimo Federici.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levy-Shraga, Y., Elisha, N., Ben-Ami, M. et al. Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic. Acta Diabetol 53, 27–33 (2016). https://doi.org/10.1007/s00592-015-0734-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-015-0734-z

Keywords

Search

Navigation