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From pediatric to adult care: a survey on the transition process in type 1 diabetes mellitus and the diabetes services in Italy

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Abstract

Aims

The present study assessed the transitioning process of young adults with type 1 diabetes mellitus (T1D) in Italy.

Materials and methods

We asked Pediatric Diabetes Centers (PDC) and Adult Diabetes Centers (CAD) to fill in a web-based survey on the current state of services, the number of transitioning adolescents with T1D within the last year, observations on limitations, and future directions.

Results

93 centers (46 PDCs, 47 CADs) joined the study. The total number of subjects with T1D being followed by a PDC was 16,261 (13,779 minors and 2483 young adults), while CADs had 25,500 patients. The survey showed an uneven situation. Only some services had a dedicated diabetes team (78% of PDCs, 64% of CADs). 72% of PDCs and 58% of CADs reported a protocol dedicated to transition. The median age for transition was 19 (range 16–25 years); the time required for preparing transition, indicated by both PDCs and CADs, was 5.5 months. A high percentage of CADs (80%) confirmed receiving sufficient clinical information, mainly through paper or computerized reports. The transition process is hampered by a lack of resources, logistical facilities, and communication between services. While some services have a protocol, monitoring of results is only carried out in a few cases. Most specialists expressed the need to enhance integration and continuity of treatment.

Conclusions

The current situation could be improved. Applying standard guidelines, taking into consideration both clinicians’ and patients’ necessities, would lead to a more successful transition process.

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Data availability

Data used to support the findings of this study are available upon request by contacting the authors directly (corresponding author: Vanna Graziani).

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Acknowledgements

The authors thank the participating diabetes centers and the whole study staff for their contribution. The authors would like to acknowledge Chiara Pandolfini and Jacopo Colla for language editing.

TransiDEA study group:

TransiDEA group members: Maurizio Bonati, Antonio Clavenna, Nicoletta Raschitelli, Francesca Scarpellini, Elisa Roberti, Rita Campi, Michele Giardino and Michele Zanetti make up the organizing and management group; Diabetes (D): Vanna Graziani, Tosca Suprani, Paolo Di Bartolo, Federico Marchetti; Epilepsy (E): Maria Paola Canevini, Ilaria Vigano'; ADHD (A): Ilaria Costantino, Valeria Tessarollo; Scientific Technical Committee (CTS): Giampaolo Ruffoni

Pediatric centers (in alphabetical order by city): Ancona (Cherubini V), Aosta (Bechaz M), Bari (Delvecchio M), Bari (Piccino E), Bologna (Zucchini S), Bologna (Maltoni G). Brindisi (Gallo F), Cagliari (De Mario R), Cagliari (Frongia P), Cagliari (Ripoli C), Caltanissetta (La Loggia A), Casarano (LE) (Cardinale G), Caserta (Perrotta A), Castrovillari (CS) (Stamati F), Catania (Lo Presti D), Crema (Calzi E), Francavilla Fontana (BR) (Coccioli MS), Cetraro (CS) (De Bernardinis F), Chieti (Tumini S), Firenze (Toni S), Forlì (Mainetti B), Genova (Minuto N), Iglesias (Maccioni R), Legnano (MI) (Macellari P), Milano (Rigamonti A), Milano (Bonfanti R), Modena (Predieri B), Napoli (Iafusco D), Novara (Rabbone I), Olbia (Piredda G), Parma (Iovine B), Parma (Lazzeroni P), Pisa (Randazzo E), Ravenna-Cesena (Dal Bo S), Ravenna-Cesena (Monti S), Reggio Emilia (Lasagni A), Roma (Patera P), Roma (Schiaffini R), San Giovanni Rotondo (FG) (Rutigliano I), Torino (Tinti D), Tradate (VA) (Guerraccio LP), Trento (Franceschi R), Trento (Cauvin V), Treviso (Corò A), Verona (Marigliano M), Vicenza (Immaurato S), Vicenza (Palma L), Viterbo (Arnaldi C).

Adult centers (in alphabetical order by city): Alessandria (Gallo M), Bari (Modugno M), Bassano del Grappa (VI) (Beltramello G), Bologna (Pagotto U), Borgomanero-Arona (NO) (Ponziani MC), Brescia (Girelli A), Catania (Di Mauro M), Cava de’ Tirreni (SA) (Fresa R), Carrara (Bacetti F), Chiavari (GE) (Ponzani P), Chivasso (TO) (Fornengo R), Cittadella (PD) (Simioni N), Como (Scinagulla L), Desio (MB) (Spreafico E), Ferrara (Monesi M), Firenze (Baggiore CM), Gaeta (LT) (Sepe M), Grosseto (Sambuco L), Iglesias – Carbonia (Guaita G), Livorno (Di Cianni G), Milano (Pintaudi B), Milano (Scavini M), Milano (Bertuzzi F), Modena (Piani D), Monfalcone (GO) (Assaloni R), Montecchio Emilia (RE) (Michelini M), Napoli (De Riu S), Padova (Avogaro A), Palermo (Ridola G), Parma (Buonadonna R), Pescara (Antonacci E), Piacenza (Bianco M), Pietra Ligure (SV) (Goretti R), Pordenone (Zanette G), Reggio Emilia (Manicardi E), Rimini (Babini A), Roma (Sabetta F), Salerno (Capuano G), Siena (Dotta F), Vimercate (MB) (Mangone I), Vimercate (MB) (Marelli G), Viterbo (Grande C).

Funding

The study is a component of the Italian Ministry of Health-funded initiative called “Transition care between adolescent and adult services for young people with chronic health needs in Italy” (RF-2019-12371228); AUSL della Romagna (F Marchetti).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy

    Vanna Graziani, Tosca Suprani & Federico Marchetti

  2. Diabetes Clinic, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy

    Paolo Di Bartolo

Authors
  1. Vanna Graziani
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  2. Tosca Suprani
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  3. Paolo Di Bartolo
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  4. Federico Marchetti
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Consortia

TransiDEA study group

  • Maurizio Bonati
  • , Antonio Clavenna
  • , Nicoletta Raschitelli
  • , Francesca Scarpellini
  • , Elisa Roberti
  • , Rita Campi
  • , Michele Giardino
  • , Michele Zanetti
  • , Vanna Graziani
  • , Tosca Suprani
  • , Paolo Di Bartolo
  • , Federico Marchetti
  • , Maria Paola Canevini
  • , Ilaria Viganò
  • , Ilaria Costantino
  • , Valeria Tessarollo
  • , Giampaolo Ruffoni
  • , V. Cherubini
  • , M. Bechaz
  • , M. Delvecchio
  • , E. Piccinno
  • , S. Zucchini
  • , G. Maltoni
  • , F. Gallo
  • , R. De Mario
  • , P. Frongia
  • , C. Ripoli
  • , A. La Loggia
  • , G. Cardinale
  • , A. Perrotta
  • , F. Stamati
  • , D. Lo Presti
  • , E. Calzi
  • , M. S. Coccioli
  • , F. De Bernardinis
  • , S. Tumini
  • , S. Toni
  • , B. Mainetti
  • , N. Minuto
  • , R. Maccioni
  • , P. Macellaro
  • , A. Rigamonti
  • , R. Bonfanti
  • , B. Predieri
  • , D. Iafusco
  • , I. Rabbone
  • , G. Piredda
  • , B. Iovine
  • , P. Lazzeroni
  • , E. Randazzo
  • , S. Dal Bo
  • , S. Monti
  • , A. Lasagni
  • , P. Patera
  • , R. Schiaffini
  • , I. Rutigliano
  • , D. Tinti
  • , L. P. Guerraccio
  • , R. Franceschi
  • , V. Cauvin
  • , A. Corò
  • , M. Marigliano
  • , S. Immaurato
  • , L. Palma
  • , C. Arnaldi
  • , M. Gallo
  • , M. Modugno
  • , G. Beltramello
  • , U. Pagotto
  • , M. C. Ponziani
  • , A. Girelli
  • , M. Di Mauro
  • , R. Fresa
  • , F. Bacetti
  • , P. Ponzani
  • , R. Fornengo
  • , N. Simioni
  • , L. Sciangula
  • , E. Spreafico
  • , M. Monesi
  • , C. M. Baggiore
  • , M. Sepe
  • , L. Sambuco
  • , G. Guaita
  • , G. Di Cianni
  • , B. Pintaudi
  • , M. Scavini
  • , F. Bertuzzi
  • , D. Piani
  • , R. Assaloni
  • , M. Michelini
  • , S. De Riu
  • , A. Avogaro
  • , G. Ridola
  • , R. Buonadonna
  • , E. Antonacci
  • , M. Bianco
  • , R. Goretti
  • , G. Zanette
  • , E. Manicardi
  • , A. Babini
  • , F. Sabetta
  • , G. Capuano
  • , F. Dotta
  • , I. Mangone
  • , G. Marelli
  •  & C. Grande

Contributions

Conceptualization, coordination and methodology were contributed by VG, TS, FM and the TransiDEA Group. First draft of the manuscript was contributed by VG, TS, PDB, FM. Writing—review and editing, was contributed by all authors. Project administration was contributed by FM. All participants of the TransiDEA group discussed and approved the final version of the manuscript. Supervision: FM.

Corresponding author

Correspondence to Vanna Graziani.

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Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose. The authors have no relevant financial or non-financial interests to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Institutional review board statement

The study was notified to the IRCCS “Carlo Besta” Foundation Ethics Committee (8 September 2021, protocol n. 87). The study was performed following the ethical standards of the 1964 Declaration of Helsinki and its later amendments. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Ethical standard

The study was notified to the IRCCS "Carlo Besta" Foundation Ethics Committee (8 September 2021, protocol n. 87). The study was performed following the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was not required for the research as no patient recruitment was carried out and no personal data was collected.

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Graziani, V., Suprani, T., Di Bartolo, P. et al. From pediatric to adult care: a survey on the transition process in type 1 diabetes mellitus and the diabetes services in Italy. Acta Diabetol (2024). https://doi.org/10.1007/s00592-024-02268-3

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