Adherence to Type 1 Diabetes Care Visits After Transfer From Pediatric to Adult Care: A Prospective Cohort Study.

Q3 Medicine

Diabetes Spectrum Pub Date : 2025-06-18 eCollection Date: 2025-01-01 DOI:10.2337/ds24-0090

Simon Lafontaine, Elise Mok, Jennifer Frei, Kaberi Dasgupta, Elham Rahme, Marc Dorais, Lorraine Bell, Meranda Nakhla

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Abstract

Objective: The objectives of this study were to describe health care utilization by adolescents and young adults with type 1 diabetes after transfer from pediatric to adult care and to determine predictors of nonadherence to diabetes care visits after this transition.

Research design and methods: This was a prospective cohort study following adolescents with type 1 diabetes for 18 months after their last pediatric visit from 2017 to 2021. We assessed health care utilization using Quebec health administrative data. The primary exposure was delay in establishing adult diabetes care, defined as a delay of >6 months between the last pediatric and the first adult diabetes care visit. Secondary exposures were self-reported self-efficacy, transition readiness, and diabetes distress before transferring to adult care. The primary outcome was nonadherence, defined as having gap(s) of >6 months between adult diabetes care visits. Secondary outcomes were one or more diabetes-related emergency department (ED) visit and one or more diabetes-related hospitalization. We used multivariable logistic regression to identify predictors of nonadherence to diabetes care visits after transition to adult care.

Results: Fifteen of 74 participants (20%) had delays in establishing adult diabetes care. Twenty participants (27%) were nonadherent to adult diabetes care visits. Six participants (8.1%) had one or more ED visit, and one participant (1.4%) was hospitalized after transferring to adult care. Delay in establishing adult care was associated with subsequent nonadherence to adult diabetes care visits (adjusted odds ratio 29.9, 95% CI 5.3-169.9).

Conclusion: Health care utilization after transfer to adult care is suboptimal in young adults with type 1 diabetes. Delayed transfer of care puts young adults at risk of disengaging from adult diabetes care.

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1型糖尿病患者从儿科转到成人护理后的依从性：一项前瞻性队列研究。

目的：本研究的目的是描述1型糖尿病青少年和年轻人从儿科转到成人护理后的医疗保健利用情况，并确定这种转变后糖尿病护理就诊不依从的预测因素。研究设计和方法：这是一项前瞻性队列研究，随访1型糖尿病青少年，从2017年至2021年最后一次儿科就诊后18个月。我们使用魁北克卫生管理数据评估卫生保健利用情况。主要暴露是建立成人糖尿病护理的延迟，定义为最后一次儿科和第一次成人糖尿病护理访问之间的延迟60个月。第二次暴露是自我报告的自我效能，过渡准备和糖尿病困扰，然后转移到成人护理。主要结局为不依从，定义为两次成人糖尿病护理访问之间有60个月的间隔。次要结局是一次或多次与糖尿病相关的急诊科就诊和一次或多次与糖尿病相关的住院治疗。我们使用多变量逻辑回归来确定过渡到成人护理后不坚持糖尿病护理就诊的预测因素。结果：74名参与者中有15名（20%）在建立成人糖尿病护理方面有延迟。20名参与者（27%）未遵守成人糖尿病护理就诊。6名参与者（8.1%）有一次或多次急诊科就诊，1名参与者（1.4%）在转入成人护理后住院。延迟建立成人护理与随后不遵守成人糖尿病护理就诊相关（校正优势比29.9,95% CI 5.3-169.9）。结论：1型糖尿病青年患者转到成人护理中心后的保健服务利用率不理想。延迟转移护理使年轻人面临脱离成人糖尿病护理的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes Spectrum Medicine-Internal Medicine

CiteScore

2.70

自引率

0.00%

发文量

期刊介绍： The mission of Diabetes Spectrum: From Research to Practice is to assist health care professionals in the development of strategies to individualize treatment and diabetes self-management education for improved quality of life and diabetes control. These goals are achieved by presenting review as well as original, peer-reviewed articles on topics in clinical diabetes management, professional and patient education, nutrition, behavioral science and counseling, educational program development, and advocacy. In each issue, the FROM RESEARCH TO PRACTICE section explores, in depth, a diabetes care topic and provides practical application of current research findings.