Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care

Authors

Kaye Farrell, New South Wales Centre for Evidence Based Health Care Australia, University of Western Sydney, Westmead HospitalFollow
Ritin S. Fernandez, University of Wollongong, Centre for Evidence Based Initiatives in Health Care, University of SydneyFollow
Yenna Salamonson, Centre for Applied Nursing Research, Ingham Institute For Applied Medical Research, Universty of Western SydneyFollow
Rhonda Griffiths, Universty of Western Sydney, New South Wales Centre for Evidence Based Health Care Australia
D J. Holmes-Walker, Westmead Hospital, University of Sydney

RIS ID

125529

Publication Details

Farrell, K., Fernandez, R., Salamonson, Y., Griffiths, R. & Holmes-Walker, D. J. (2018). Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care. Diabetes Research and Clinical Practice, 139 163-169.

Abstract

Aims: To identify (a) determinants of glycated haemoglobin (HbA1c) at 18 and 30 months following transition in young people with Type 1 diabetes mellitus (T1DM) to a youth-specific diabetes service; and to (b) evaluate the impact of the service on acute admissions with diabetic ketoacidosis (DKA) over a 14-year period.

Methods: An audit of records of youth with T1DM referred from paediatric services to the multidisciplinary transition service at Westmead Hospital, from 2001 to 2012, and followed-up to 2014.

Results: Data from 439 adolescents and young adults (Median age: 18) were analysed. The recommended standard of glycaemic control, HbA1c < 7.5% (58 mmol/mol), was achieved by 23% at baseline, 22% at 18-months, and 20% at 30-month. After adjusting for lag time ( > 3 months) and diabetes duration ( > 7 years), glycaemic control at first visit predicted subsequent glycaemic control at 18-month and 30-month follow-up. From 2001 to 2014, only 8.6% were lost to follow-up; admissions and readmissions for DKA reduced from 72% (32/47) to 4% (14/340) (p < 0.001). Furthermore, mean length of stay (LOS) significantly decreased from 6.56 to 2.36 days (p < 0.001).

Conclusions: Continuing engagement with the multidisciplinary transition service prevented deterioration in HbA1c following transition. Age-appropriate education and regular follow-up prevents DKA admissions and significantly reduced admission LOS.