Quality of diabetes mellitus healthcare and metabolic control during transition from paediatric to adult care: A systematic review and meta-analysis

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-08-20 DOI:10.1111/dme.70125

Giovanna Donvito, Carlo Maltecca, Sabine E. Hofer, Dagmar Meraner, Uwe Siebert, Marjan Arvandi

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Abstract

Aims

Emerging adults with chronic diseases like diabetes often experience a decline in health during the process of transition from paediatric to adult healthcare. This study assesses the impact of transition on healthcare quality of people with diabetes, focusing on glycated haemoglobin (HbA_1c).

Methods

We conducted a systematic review and meta-analysis of the difference in HbA_1c before and after transition following the PRISMA guidelines. A comprehensive search across four databases for studies of diabetes type 1 and 2 published between 2018 and 2024 was conducted. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies.

Results

Twenty studies were included in the systematic review, fifteen to the meta-analysis. Eleven studies considered a structured or semi-structured transition programme: three reported a reduction in HbA_1c (improved glycaemic control) and eight no significant difference. Nine studies considered no transition programme: four showed a worsening of glycaemic control and five no significant difference. Overall, the meta-analysis showed a worsening of glycaemic control post-transition with mean difference (MD) −1.75 mmol/mol (−0.16%) [95% confidence interval (CI) –5.24–1.75 mmol/mol (−0.48%–0.16%)], with considerable heterogeneity, where negative values indicate higher HbA_1c post-transition. Subgroup analysis for transition programmes and usual care showed, respectively, significant improvement and worsening of glycaemic control with MD of 3.28 mmol/mol (0.30%) [95% CI 0.44–6.12 mmol/mol (0.04%–0.56%)] and −6.99 mmol/mol (−0.64%) [95% CI −11.79 to −2.19 mmol/mol (−1.08% to −0.20%)].

Conclusions

Findings suggest that the transition to adult care may negatively affect glycaemic control in emerging adults with diabetes, whereas structured transition programmes can neutralize this effect and prevent consequences. Further investigations are needed to develop evidence-based guidelines for optimizing transition interventions.

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查看原文本刊更多论文

从儿科到成人护理过渡期间糖尿病保健和代谢控制的质量：系统回顾和荟萃分析。

目的：患有糖尿病等慢性疾病的新生成人在从儿科保健向成人保健过渡的过程中，健康状况经常下降。本研究评估了转变对糖尿病患者医疗质量的影响，重点关注糖化血红蛋白（HbA1c）。方法：我们对遵循PRISMA指南的转换前后HbA1c的差异进行了系统回顾和荟萃分析。在四个数据库中对2018年至2024年间发表的1型和2型糖尿病研究进行了全面搜索。对非随机研究使用ROBINS-I工具评估偏倚风险。结果：20项研究纳入系统评价，15项纳入荟萃分析。11项研究考虑结构化或半结构化过渡方案：3项报告HbA1c降低（改善血糖控制），8项无显著差异。九项研究没有考虑过渡方案：四项研究显示血糖控制恶化，五项研究没有显著差异。总体而言，meta分析显示转换后血糖控制恶化，平均差值（MD）为-1.75 mmol/mol(-0.16%)[95%置信区间（CI）为-5.24-1.75 mmol/mol(-0.48%-0.16%)]，具有相当大的异质性，其中阴性值表明转换后HbA1c较高。过渡方案和常规护理的亚组分析分别显示，血糖控制显著改善和恶化，MD为3.28 mmol/mol (0.30%) [95% CI 0.44-6.12 mmol/mol(0.04%-0.56%)]和-6.99 mmol/mol (-0.64%) [95% CI -11.79至-2.19 mmol/mol(-1.08%至-0.20%)]。结论：研究结果表明，过渡到成人护理可能会对初发成人糖尿病患者的血糖控制产生负面影响，而结构化的过渡方案可以中和这种影响并预防后果。需要进一步调查，以制定优化过渡干预措施的循证指南。

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

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”