Aim: The transition from pediatric to adult care is characterized by inadequate medical follow-up, poor self-management, and higher risk for adverse outcomes. We aimed to determine whether self-efficacy, transition readiness or diabetes distress are associated with glycemic control (HbA1c) among adolescents with T1D during the transition period.
Methods: Cross-sectional study of adolescents (ages 17 years) with T1D followed at the Montreal Children's Hospital diabetes clinic. Adolescents were recruited during the year prior to transfer to adult care and completed validated questionnaires on self-efficacy, transition readiness (TRAC) and diabetes distress (T1-DDS). Primary outcome: mean HbA1c (%) during the year prior to transfer. To analyse the association between our exposures and HbA1c, we used Pearson correlation and Chi Square test.
Results: We recruited 74 adolescents with T1D (29 male, 39.2%). Mean age (+SD) at diagnosis was 9.1 (+4.0) years and age at transition (last pediatric diabetes visit) was 17.9 (+0.2) years. Mean diabetes duration was 8.5 (+4.0) years. Mean HbA1c was 8.88% (+1.33%). Six adolescents (8.1%) had HbA1c <7.5%, 39 (52.7%) between >7.5- <9.0 % and 29 (39.2%) > 9.0 %. Twenty-eight adolescents (37.8%) had TRAC scores >8, indicating transition readiness and 10 (13.5%) had T1-DDS total scores >3, indicating diabetes distress. Transition readiness was associated with lower HbA1c (r=-0.34, p=0.003). Amongst those with poor glycemic control (HbA1c >9.0), 50% were not ready for transition compared with 21% deemed ready for transition (p=0.015). 80% of adolescents with diabetes distress had poor glycemic control compared with 33% without diabetes distress (p=0.004). Higher self-efficacy scores were associated with lower HbA1c (r=-0.29, p=0.012).
Conclusion: Efforts to improve healthcare transition should focus on improving self-efficacy and transition readiness while addressing diabetes distress so as to support adolescents in developing their autonomy and in preparing them for an adult model of care.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology