Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care

K Farrell; R Fernandez; Y Salamonson; R Griffiths; D J Holmes-Walker

doi:10.1016/j.diabres.2018.03.013

Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care

Diabetes Res Clin Pract. 2018 May:139:163-169. doi: 10.1016/j.diabres.2018.03.013. Epub 2018 Mar 10.

Authors

K Farrell¹, R Fernandez², Y Salamonson³, R Griffiths⁴, D J Holmes-Walker⁵

Affiliations

¹ School of Nursing and Midwifery, University of Western Sydney, New South Wales, Australia; New South Wales Centre for Evidence Based Health Care Australia: a Collaborating Centre of the Joanna Briggs Institute, Australia; Westmead Hospital, Westmead, New South Wales, Australia. Electronic address: kaye.farrell@health.nsw.gov.au.
² School of Nursing and Midwifery, University of Wollongong, New South Wales, Australia; Centre for Evidence Based Initiatives in Health Care: an Affiliate Centre of the Joanna Briggs Institute, Australia; School of Medicine, University of Sydney, Australia.
³ School of Nursing and Midwifery, University of Western Sydney, New South Wales, Australia; Centre for Applied Nursing Research (CANR), Australia; Ingham Institute for Applied Medical Research, Australia.
⁴ School of Nursing and Midwifery, University of Western Sydney, New South Wales, Australia; New South Wales Centre for Evidence Based Health Care Australia: a Collaborating Centre of the Joanna Briggs Institute, Australia.
⁵ Westmead Hospital, Westmead, New South Wales, Australia; School of Medicine, University of Sydney, Australia.

PMID: 29534994
DOI: 10.1016/j.diabres.2018.03.013

Abstract

Aims: To identify (a) determinants of glycated haemoglobin (HbA1c) at 18 and 30 months following transition in young people with Type 1 diabetes mellitus (T1DM) to a youth-specific diabetes service; and to (b) evaluate the impact of the service on acute admissions with diabetic ketoacidosis (DKA) over a 14-year period.

Methods: An audit of records of youth with T1DM referred from paediatric services to the multidisciplinary transition service at Westmead Hospital, from 2001 to 2012, and followed-up to 2014.

Results: Data from 439 adolescents and young adults (Median age: 18) were analysed. The recommended standard of glycaemic control, HbA1c < 7.5% (58 mmol/mol), was achieved by 23% at baseline, 22% at 18-months, and 20% at 30-month. After adjusting for lag time (>3 months) and diabetes duration (>7 years), glycaemic control at first visit predicted subsequent glycaemic control at 18-month and 30-month follow-up. From 2001 to 2014, only 8.6% were lost to follow-up; admissions and readmissions for DKA reduced from 72% (32/47) to 4% (14/340) (p < 0.001). Furthermore, mean length of stay (LOS) significantly decreased from 6.56 to 2.36 days (p < 0.001).

Conclusions: Continuing engagement with the multidisciplinary transition service prevented deterioration in HbA1c following transition. Age-appropriate education and regular follow-up prevents DKA admissions and significantly reduced admission LOS.

Keywords: Clinic attendance; Diabetic ketoacidosis; Glycated haemoglobin; Transition; Type 1 diabetes mellitus.

MeSH terms

Adolescent
Adult
Delivery of Health Care / standards*
Diabetes Mellitus, Type 1 / therapy*
Female
Humans
Male
Time Factors
Transition to Adult Care / standards*
Young Adult