Introduction: Transition of young adults with diabetes has received much attention in recent years. Despite concerns regarding deterioration in glycaemic control and lack of engagement in services following transfer of care from paediatric to adult services, very few studies have looked at the effect of transfer on glycaemic control and clinic attendance as the primary outcome.
Objectives: To establish the glycaemic control and rate of microvascular complications in adolescents and young adults with childhood onset type 1 diabetes mellitus (T1DM) before and after transfer from paediatric to adult care at a single centre.
Methods: Data was collected from our electronic database on patients with T1DM currently attending transition clinic and those transferred to adult services between August 2009 and 2012.
Results: Hundred and four (55 males) patients with a median age of 19.2 years were identified. Mean (±S.D.) age at diagnosis and duration of diabetes were 9.2(±3.8) and 9.4(±3.9) years respectively. Mean HbA1c was 77±18 mmol/mol. Microalbuminuria was noted in 8.6% and retinopathy in 43.2%, with the majority (41.3%) having only background changes. Fifty four patients were in transition and 50 post transfer to adult care. In the latter group, mean age of transfer was 18.5(±1.2) years. Mean HbA1c 1 year pre and post transfer was similar (78±20 and 78±22 mmol/mol, respectively; P=0.22). Mean HbA1c 2 and 3 years post transfer were also similar. Although clinic appointments became less frequent following transfer, failure to attend rate did not change. A small subset of patients (n=7) who opted for e-mail support demonstrated improved mean HbA1c over 1 year from 68±8 to 63±10 mmol/mol, P=0.051.
Conclusions: Glycaemic control and clinic attendance is stable following transfer of care of young diabetes patients. Background retinopathy is present in a large percentage of patients. Email support may represent one strategy to improve engagement and diabetes control in this population and warrants further investigation.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology