Young Adult Diabetes Technology Use in Pediatric as Compared to Adult Practices.

Abstract

Objective: People with type 1 diabetes (T1D) are more likely to have high hemoglobin A1C (HbA1C) levels in emerging adulthood. The transition to adult practices is often difficult, and the ideal age for transfer is unclear. We aimed to characterize differences in disease outcomes and care between pediatric and adult institutions for young adults (YAs) with T1D.

Methods: We conducted a retrospective review of patients aged 18 to 23 years, using data from the T1D Exchange (January 1, 2022 to December 31, 2023) and categorized patients according to location of care (n = 8538 from pediatric institutions, n = 839 from adult institutions). We compared group characteristics in an unadjusted manner and then used logistic regression to compare rates of optimal (HbA1C <7.0%) and poor (HbA1C >9%) diabetes control, acute complications, and technology use between groups.

Results: Those at adult institutions were older at time of analysis (mean: 21.4 vs 20 years) and more likely to have undocumented insurance (21% vs 2%). Technology use was high in both populations. However, adjusting for covariates, those in adult institutions were more likely to have poor control (odds ratio [OR] 1.23, P = .03) and less likely to use a continuous glucose monitor (OR 0.64, P < .001) or an insulin pump (OR 0.62, P < .001).

Conclusion: YAs receiving care in adult versus pediatric centers appear more likely to have poor diabetes control and less likely to use diabetes technology. The findings are limited by unequal regional representation and smaller adult center population. Research is needed to identify barriers to technology use for YAs particularly in adult practices.