Transitioning to Adult Care May Worsen Glycemic Control in Type 2 Diabetes

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Older age during diagnosis and duration of diabetes were associated with increased chance of leaving pediatric care.
Older age during diagnosis and duration of diabetes were associated with increased chance of leaving pediatric care.

During the transfer from pediatric to adult care, young adults with type 2 diabetes have worsening glycemic control and may be lost to follow-up, according to results published in Diabetic Medicine.

The results of the study stress the need for the development of clinical programs and healthcare policies specifically created for the increasing population of young adults with youth-onset type 2 diabetes.

The study included participants from the SEARCH for Diabetes in Youth Study (SEARCH) who had been diagnosed with type 2 diabetes between 2002 and 2005, had an initial SEARCH visit before age 18 years while in pediatric care, and had at least 1 follow-up SEARCH visit from ages 18 to 25 years (n=182).

Of the 182 participants, 56% (n=102) said they had switched from pediatric to adult care at follow-up compared with 15% (n=28) who reported no care and 29% who did not transfer from pediatric to adult care.

Participants' duration of diabetes (odds ratio [OR], 1.4; 95% CI, 1.1-1.8) and age at diagnosis (OR, 1.8; 95% CI, 1.4-2.4) predicted leaving pediatric care. Switching to adult care or no care was associated with a higher likelihood of poor glycemic control at follow-up (adult, OR, 4.5 [95% CI, 1.8-11.2]; none, OR, 4.6 [95% CI, 1.4-14.6]), independent of sex, age, race/ethnicity, or baseline HbA1c level.

"Concerted efforts to train endocrinologists and primary care practitioners to incorporate developmentally appropriate approaches to young adult care, implementation of standardized clinical care pathways which bridge paediatric and adult medical systems, and recognition of the need for more ancillary support services, especially social work and psychosocial support, ultimately will be needed to curb this emergent problem," the researchers wrote.

Reference

Agarwal S, Raymond JK, Isom S, et al. Transfer from paediatric to adult care for young adults with type 2 diabetes: the SEARCH for diabetes in youth study [published online January 27, 2018]. Diabetic Med. doi: 10.1111/dme.13589

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