Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with Type 1 diabetes. Issue 12 (26th May 2014)

• Record Type: Journal Article
• Authors: Pyatak, E. A.; Sequeira, P. A.; Whittemore, R.; Vigen, C. P.; Peters, A. L.; Weigensberg, M. J.
• Is Part Of: Diabetic medicine. Volume 31:Issue 12(2014:Dec.)
• Page Start: 1615
• Page End: 1624
• Publication Date: 2014-05-26
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12485
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12485-abs-0001"> <title>Abstract</title> <sec id="dme12485-sec-0001" sec-type="section"> <title>Aim</title> <p>To examine challenges contributing to disruptions in care during the transition from paediatric to adult care among young adults with Type 1 diabetes who are primarily in ethnic minority groups and have low socio‐economic status.</p> </sec> <sec id="dme12485-sec-0002" sec-type="section"> <title>Methods</title> <p>Participants (<italic>n </italic>=<italic> </italic>20) were newly enrolled patients in a transition clinic for young adults with Type 1 diabetes with a history of loss to medical follow‐up. Participants completed qualitative semi‐structured interviews detailing their transition experiences in addition to demographic, HbA<sub>1c</sub> and psychosocial measures. Descriptive statistics were completed for quantitative data, and narrative thematic analysis of interviews was used to identify common themes. A mixed‐method analysis was used to identify the associations between stressors identified in interviews and clinical and psychosocial variables.</p> </sec> <sec id="dme12485-sec-0003" sec-type="section"> <title>Results</title> <p>Three categories of challenges contributing to loss to follow‐up were identified: psychosocial challenges, health provider and health system challenges and developmental challenges. Participants experienced a high degree of stressful life circumstances which were associated with higher HbA<sub>1c</sub> (<italic>r </italic>=<italic> </italic>0.60, <italic>P </italic>=<italic> </italic>0.005), longer duration of loss to follow‐up (<italic>r </italic>=<italic> </italic>0.51, <italic>P </italic>=<italic> </italic>0.02), greater emergency department utilization (<italic>r </italic>=<italic> </italic>0.45, <italic>P </italic>=<italic> </italic>0.05), and lower life satisfaction (<italic>r </italic>=<italic> </italic>‐0.62, <italic>P </italic>=<italic> </italic>0.003).</p> </sec> <sec id="dme12485-sec-0004" sec-type="section"> <title>Conclusions</title> <p>A confluence of challenges, including stressful life circumstances, healthcare system barriers and the developmental trajectory of young adulthood, contributes to a high risk of loss to follow‐up and poor health in this population of young adults with Type 1 diabetes. An integrated approach to transition addressing medical and psychosocial needs may facilitate improved follow‐up and health outcomes in clinical settings.</p> </sec> </abstract>