Type 1 Diabetes Mellitus and Transfer from Pediatric to Adult Care: A Single-Center Experience.

Abstract

Introduction: Type 1 diabetes mellitus (T1D) necessitates lifelong management, and a standardized transition protocol with multidisciplinary support can help ease the shift from pediatric-focused healthcare to adult care systems.

Aim: Our objective was to assess the sociodemographic data, clinical features, and laboratory parameters that may influence the transition period and post-transition process among patients with T1DM and to compare results between two different transition models.

Methods: We retrospectively analyzed 64 T1D patients who transitioned to the adult outpatient clinic at Istanbul University, Istanbul Faculty of Medicine. Patients were followed up between 2001 and 2022, completed their pediatric follow-up, and participated in the shift from pediatric to adult outpatient care. Demographic data, clinical and metabolic parameters before and after the transition, the presence of diabetic complications and comorbidities, and treatment modalities were analyzed. These patients were transferred to adult care with two different transition models: in model 1, the transition was performed in a single meeting, whereas in model 2, it was performed over a period of 4-6 months. Due to pandemic-related disruptions, a few patients were transferred following telephone consultations and were excluded from model comparisons. The differences between the outcomes of the transition models were also examined.

Results: Sixty-four patients were included in the analysis (43.7% female, age at diagnosis 9.4±3.9 years). At their last pediatric visit, the participants had a mean age of 19.4 ± 1.2 years (range 16.6-21.9). The mean age at transfer to adult care was 20.2 ± 1.4 years (17.7-23.1), and the mean age at the most recent adult visit was 23.2 ± 4.2 years (18.4-39.5). The median time in adult care follow-up was 3.3 (range 0.3-20.9) years. The mean body mass index (BMI) decreased from 24.1 ± 1.7 kg/m² at transition to 23.6 ± 3.5 kg/m² during adult follow-up. Although the mean BMI fell slightly, obesity prevalence rose from 1.6 % to 9.6 %, reflecting a right-shift in the BMI distribution. Annual routine diabetes-care visits decreased from 3.0 ± 0.9 visits per year during pediatric follow-up to 2.1 ± 1.8 visits per year in adult care (p=0.009). The mean HbA1c level was significantly lower in adults (8.9% vs. 8.3%; p=0.007). Total insulin doses were significantly higher at transition than at the last adult care visit (0.95 vs 0.75 IU/kg/day; p=0.009). Basal insulin ratio was higher in adulthood (43.1% vs. 52.8%; p<0.0001). The use of continuous subcutaneous insulin infusion (CSII) therapy in adult care was higher (4.7% vs. 12.5%, p=0.11). The frequency of autoimmune thyroiditis and coeliac disease did not differ between adult and pediatric care. Although the frequency of microvascular and macrovascular complications increased in adult care, there was no statistically significant variation in acute and chronic complications. There were no statistically significant differences in glycemic outcomes, insulin requirements, or complication rates between transition models 1 and 2.

Conclusion: We conclude that a structured transition process may support better glycemic control and improved treatment adaptation in T1D management regardless of the model whether it involves a single-session or a gradual model, HbA1c levels improved during adult care, along with reduced insulin doses and increased basal insulin ratios. However, no significant difference was found between the two structured transition models, emphasizing the need for individualized and supportive approaches during this process.