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Comorbidities, low education level increase risks during transition to adult care in type 1 diabetes

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March 30, 2017

Young adults with type 1 diabetes transitioning from pediatric to adult care are more likely to experience poor glycemic control if they had a higher HbA1c before transition, any comorbidities or no college education, compared with those who had lower HbA1c before transition, no comorbidities and a college education, according to an analysis of data from a Canadian diabetes center.

“The aim of the present study was to assess the predictors of [type 1 diabetes] outcomes in young adults who were transitioned from the pediatric diabetes clinic to the adult diabetes clinic in one tertiary diabetes center with relatively uniform pediatric diabetes care, method of transition and adult diabetes care, allowing isolation of the effect of patient characteristics to help us predict who will have poorer outcomes and, accordingly, to adopt modified strategies and closer follow-up for those participants during the transition period,” Abeer Alassaf, MD, assistant professor of pediatrics at the University of Jordan, and colleagues wrote.

In a retrospective study, Alassaf and colleagues analyzed data from 102 young adults with type 1 diabetes followed from 1 year before to 1 year after the transfer from pediatric to adult care in a Canadian tertiary diabetes center (55% men; mean age, 22 years; mean age at diagnosis, 10 years). The cohort participated in a transition clinic during their final year in pediatric care at the same institution. Using clinical records and a prospective transition database, researchers assessed four post-transition outcomes: mean HbA1c in the latest year of adult care, number of hospital visits due to hyperglycemia during adult care, number of hospital visits due to hypoglycemia during adult care, and the number of diabetes clinic visits during the latest year of adult care.

Researchers used linear regression analysis to assess several independent variables as possible predictors of adult outcomes, including age at diagnosis, sex, BMI at time of transition, comorbidities, upgraded insulin regimen and pediatric metabolic control, as well as a history of any diabetes-related hospital visits during pediatric care.

Within the cohort, 68% were students at the time of the latest adult visit; 39% had comorbidities, including hypothyroidism, Graves’ disease, celiac disease, asthma and hypertension. Researchers observed correlations between pediatric and adult HbA1c values (r = 0.73; P < .001) and between the frequency of hospital visits for hyperglycemia before and after transition (r = 0.38; P < .001). There were no correlations observed between the number of annual pediatric and adult clinic visits, though clinic attendance frequency declined from a mean 2.71 visits per year to 2.09 visits per year between pediatric and adult care (P < .001).

Researchers found that the presence of any comorbidity predicted mean adult HbA1c (mean HbA1c difference, 0.71%; 95% CI, 0.15-1.27), as did pediatric HbA1c in the last year before transition (0.67% per 1% increase in HbA1c; 95% CI, 0.51-0.84).

“In the single-center clinic population studied herein, there was no significant change in glycemic control from late pediatric to early adult care ([mean] HbA1c, 8.82% vs. 8.95%, respectively; P = .317), and there was a strong correlation suggesting that 53% of variation in young adult HbA1c is explained by HbA1c values during childhood,” the researchers wrote. “This issue is contentious in the literature, with some studies corroborating our findings, whereas others show no difference in HbA1c between pediatric and adult care.”

Predictors of hospitalization for hyperglycemia included a history of pediatric hospitalization for hyperglycemia (incidence rate ratio, 1.2; 95% CI, 1.02-1.41) and having a high school vs. university education (incidence rate ratio, 3.13; 95% CI 1.12-8.73).

“Participants with only a high school education had a 213% higher incidence of hospital admissions than participants with university education after adjusting for other variables,” the researchers wrote. “This may be explained, in part, by the association seen in univariate analysis between lower education level and poorer glycemic control.” – by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.