Improved transition to adult care in youth with type 1 diabetes: a pragmatic clinical trial.

Sonia Butalia, Susan G Crawford, K Ashlee McGuire, David K Dyjur, Julia R Mercer, Danièle Pacaud

Journal: Diabetologia 2022;64(4):758-766

PMID: 33439284

Abstract

AIMS/HYPOTHESIS

Youth with type 1 diabetes are at high risk for loss to follow-up during the transition from paediatric to adult diabetes care. Our aim was to assess the effect of a communication technology enhanced transition coordinator intervention compared with usual care on clinic attendance among transitioning youth with type 1 diabetes.

METHODS

In this open label, pragmatic clinical trial of youth with type 1 diabetes, aged 17-18 years, transitioning from paediatric to adult diabetes care, the intervention group received support from a transition coordinator who used communication technology and the control group received usual care. The primary outcome was the proportion of individuals that did not attend at least one routine clinic visit in adult diabetes care within 1 year after transfer. Secondary outcomes included diabetes-related clinical outcomes and quality of life measures.

RESULTS

There were no baseline differences in age, sex, HbA and number of follow-up visits, emergency department visits and diabetic ketoacidosis admissions in the 1 year prior to transition between the usual care (n = 101) and intervention (n = 102) groups. In the year following transfer, 47.1% in the usual care group vs 11.9% in the intervention group did not attend any outpatient diabetes appointments (p < 0.01). There were no differences in glycaemic control or diabetic ketoacidosis post transfer.

CONCLUSIONS/INTERPRETATION

Our intervention was successful in improving clinic attendance among transitioning youth with type 1 diabetes. Importantly, this programme used simple, readily accessible communication technologies, which increases the sustainability and transferability of this strategy.

TRIAL REGISTRATION

isrctn.org ISRCTN13459962.

Address: Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. [email protected].; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. [email protected].; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. [email protected].; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. [email protected].; Alberta Health Services, Calgary, AB, Canada.; Provincial Primary Health Care, Alberta Health Services, Calgary, AB, Canada.; Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; Diabetes Centre Calgary, Alberta Health Services, Calgary, AB, Canada.; Alberta Children's Hospital, Diabetes Clinic, Alberta Health Services, Calgary, AB, Canada.; Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

DOI: 10.1007/s00125-020-05368-1