Diabetes Educator, Nutritionist Facilitate Successful Transition From Pediatric to Adult Care for Type 1 Diabetes

Adolescents and young adults with type 1 diabetes who had a visit with a certified diabetes educator or a nutritionist, or who used a continuous glucose monitor were found to have a smaller gap in health care when transitioning from pediatric to adult care, according to study results presented at the 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021).

Researchers from Duke University Health System retrospectively examined the health records of 299 adolescents and young adults for clinical characteristics and healthcare utilization during their transition from pediatric to adult care. Patients who required at least 3 years to have an adult care consultation were excluded.

More than half of the participants (54.8%) were women, 73.4% were White, the median number of yearly pediatric endocrine consultations was 2.5 (interquartile range [IQR], 2.1-3), and mean glycated hemoglobin (HbA_1c) at last pediatric visit was 9.4%±2.14%. The median transition time from pediatric to adult consolations was 14.09 (IQR, 4.58-43.80) months.

The gap in care was significantly longer among patients who did not see a nutritionist, increasing by a factor of 2.03-fold (95% CI, 1.53-3.46; P <.01); the gap in care increased by 1.83-fold (95% CI, 1.10-3.05; P =.02) among patients who did not see a certified diabetes educator and by 1.67-fold (95% CI, 1.03-2.71; P =.04) among patients who did not use a continuous glucose monitor.

Gap in care during transition was not associated with HbA_1c level (P =.11), insulin pump use (P =.21), number of hospitalizations (P =.48), number of emergency department visits (P =.28), anxiety (P =.037), or depression (P =.82).

This study may not be generalizable as patients with long transition times were excluded from participation.

These data indicate that a consultation with a nutritionist or diabetes educator and use of a continuous glucose monitor are associated with shorter gaps in care during the transition from pediatric to adult health care among patients with type 1 diabetes.

Reference

Soliman D, Crowley M J, Manning A, Rikhi A, Chiswell K, Maslow G. Transition from pediatric to adult care in type 1 diabetes mellitus: A longitudinal analysis of clinical characteristics. Presented at: 2021 AACE Virtual Annual Meeting, May 26-29, 2021.