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James S, Cudizio L, Ng SM, Lyons S, Maruthur NM, Araszkiewicz A, Gomber A, Snoek F, Toft E, Weissberg-Benchell J, de Beaufort C. Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals' experiences and perceptions. Diabetes Res Clin Pract 2024; 214:111768. [PMID: 38971378 DOI: 10.1016/j.diabres.2024.111768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/22/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Youth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals' (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. METHODS Data were collected via an online global survey (seven language options), broadly advertised by the International Society for Pediatric and Adolescent Diabetes (ISPAD), European Association for the Study of Diabetes (EASD), team members and partners, via newsletters, websites, e-mails and social media. RESULTS Respondents (n = 372) were mainly physicians (74.5 %), practicing in government funded (59.4 %), paediatric (54.0 %), metropolitan settings (85.8 %) in Europe (44.9 %); 37.1 % in low and middle-income countries (LMICs). Few centers used a transition readiness checklist (32.8 %), provided written transition information (29.6 %), or had a dedicated staff member (23.7 %). Similarly, few involved a psychologist (25.8 %), had combined (35.2 %) or transition/young person-only clinics (34.9 %), or a structured transition education program (22.6 %); 49.8 % advised youth to use technology to assist the transfer. Most (91.9 %) respondents reported barriers in offering a good transition experience. Proportionally, more respondents from LMICs prioritised more funding (p = 0.01), a structured protocol (p < 0.001) and education (p < 0.001). CONCLUSION HCPs' experiences and perceptions related to transition vary widely. There is a pressing need for an international consensus transition guideline.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, Petrie, University of Melbourne, Parkville, and Western Sydney University, Campbelltown, Australia.
| | | | - Sze May Ng
- Edge Hill University, Liverpool, and Mersey and West Lancashire Teaching Hospitals National Health Service Trust, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Lyons
- Baylor College of Medicine, Houston, United States
| | - Nisa M Maruthur
- Johns Hopkins University School of Medicine, Baltimore, United States
| | | | | | - Frank Snoek
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva Toft
- Karolinska Institute, Solna, and Ersta Hospital, Stokholm, Sweden
| | | | - Carine de Beaufort
- University of Luxembourg, Luxembourg, and Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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Graziani V, Suprani T, Di Bartolo P, Marchetti F. From pediatric to adult care: a survey on the transition process in type 1 diabetes mellitus and the diabetes services in Italy. Acta Diabetol 2024; 61:1069-1076. [PMID: 38700547 DOI: 10.1007/s00592-024-02268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 08/17/2024]
Abstract
AIMS The present study assessed the transitioning process of young adults with type 1 diabetes mellitus (T1D) in Italy. MATERIALS AND METHODS We asked Pediatric Diabetes Centers (PDC) and Adult Diabetes Centers (CAD) to fill in a web-based survey on the current state of services, the number of transitioning adolescents with T1D within the last year, observations on limitations, and future directions. RESULTS 93 centers (46 PDCs, 47 CADs) joined the study. The total number of subjects with T1D being followed by a PDC was 16,261 (13,779 minors and 2483 young adults), while CADs had 25,500 patients. The survey showed an uneven situation. Only some services had a dedicated diabetes team (78% of PDCs, 64% of CADs). 72% of PDCs and 58% of CADs reported a protocol dedicated to transition. The median age for transition was 19 (range 16-25 years); the time required for preparing transition, indicated by both PDCs and CADs, was 5.5 months. A high percentage of CADs (80%) confirmed receiving sufficient clinical information, mainly through paper or computerized reports. The transition process is hampered by a lack of resources, logistical facilities, and communication between services. While some services have a protocol, monitoring of results is only carried out in a few cases. Most specialists expressed the need to enhance integration and continuity of treatment. CONCLUSIONS The current situation could be improved. Applying standard guidelines, taking into consideration both clinicians' and patients' necessities, would lead to a more successful transition process.
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Affiliation(s)
- Vanna Graziani
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy.
| | - Tosca Suprani
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy
| | - Paolo Di Bartolo
- Diabetes Clinic, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Federico Marchetti
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy
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Vaillancourt M, Mok E, Frei J, Dasgupta K, Rahme E, Bell L, Da Costa D, Nakhla M. Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a paediatric diabetes centre in Montreal, Canada. BMJ Open 2023; 13:e076524. [PMID: 37879699 PMCID: PMC10603410 DOI: 10.1136/bmjopen-2023-076524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Among youth living with type 1 diabetes (T1D), the increasing demands to diabetes self-care and medical follow-up during the transition from paediatric to adult care has been associated with greater morbidity and mortality. Inadequate healthcare support for youth during the transition care period could exacerbate psychosocial risks and difficulties that are common during emerging adulthood. The current investigation sought to explore the post-transfer perceptions of emerging adults living with T1D relating to their transition to adult care. RESEARCH DESIGN AND METHODS Thirty-three emerging adults living with T1D were recruited during paediatric care and contacted for a semistructured interview post-transfer to adult care (16.2±4.2 months post-transfer) in Montreal, Canada. We analysed data using thematic analysis. RESULTS We identified four key themes: (1) varied perceptions of the transition process from being quick and abrupt with minimal advice or information from paediatric healthcare providers (HCP) to more positive including a greater motivation for self-management and the transition being concurrent with the developmental period; (2) facilitators to the transition process included informational and tangible social support from HCPs and family or friends, a positive relationship with adult HCP and a greater ease in communicating with the adult care clinic or adult HCP; (3) barriers to adequate transition included lack of advice or information from paediatric HCPs, loss of support from HCPs and friends or family, the separation of healthcare services and greater difficulty in making appointments with adult clinic or HCP and (4) participants recommendations for improving the transition included increasing the length and frequency of appointments in adult care, having access to educational information, and better transition preparation from paediatric HCPs. CONCLUSIONS The experiences and perceptions of emerging adults are invaluable to guide the ongoing development and improvement of transition programmes for childhood-onset chronic illnesses.
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Affiliation(s)
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Lorraine Bell
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah Da Costa
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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Zurynski Y, Carrigan A, Meulenbroeks I, Sarkies MN, Dammery G, Halim N, Lake R, Davis E, Jones TW, Braithwaite J. Transition models of care for type 1 diabetes: a systematic review. BMC Health Serv Res 2023; 23:779. [PMID: 37474959 PMCID: PMC10360292 DOI: 10.1186/s12913-023-09644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/04/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited. Our aim was to synthesise the evidence for transition models and their components, examine the health related and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care. METHOD We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included. RESULTS Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6 studies), multidisciplinary team transition support (5 studies) and telehealth/virtual care (3 studies). Compared with usual practice, three of the six structured transition education programs led to improvements in maintenance of glycaemic control, psychological well-being, and engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but did not change health outcomes. CONCLUSIONS Although some health and psychosocial benefits are reported, the results were mixed. No studies reported on T1D transition model implementation outcomes such as acceptability, adoption, and appropriateness among clinicians or managers implementing these models. This gap needs to be addressed to support future adoption of successful models.
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Affiliation(s)
- Yvonne Zurynski
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia.
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mitchell N Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Genevieve Dammery
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicole Halim
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Rebecca Lake
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Jeffrey Braithwaite
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
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Hornung RJ, Reed PW, Gunn AJ, Albert B, Hofman PL, Farrant B, Jefferies C. Transition from paediatric to adult care in young people with diabetes; A structured programme from a regional diabetes service, Auckland, New Zealand. Diabet Med 2023; 40:e15011. [PMID: 36398457 DOI: 10.1111/dme.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
AIM To assess participation with a structured transition programme for adolescents with diabetes. METHODS Data from a regional cohort aged less than 16 years of age with type 1 (T1) and type 2 diabetes (T2D) in Auckland, New Zealand (2006-2016). Participation was defined as opting into a structured transition programme. RESULTS Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Māori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036). CONCLUSIONS In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Māori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.
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Affiliation(s)
- Rosalie J Hornung
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Peter W Reed
- Starship Children's Health Children's Research Centre, Auckland District Health Board, Auckland, New Zealand
| | - Alistair J Gunn
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ben Albert
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Bridget Farrant
- Centre for Youth Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Craig Jefferies
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
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Yeung J, Virella Pérez YI, Samarasinghe SC, Forsyth V, Agarwalla V, Steinbeck K. Study protocol: a pragmatic trial reviewing the effectiveness of the TransitionMate mobile application in supporting self-management and transition to adult healthcare services for young people with chronic illnesses. BMC Health Serv Res 2022; 22:1443. [PMID: 36447255 PMCID: PMC9706969 DOI: 10.1186/s12913-022-08536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Transition from paediatric to adult heath care services is a challenging time for many adolescents with chronic illnesses and may include deterioration in illness control as a consequence of inadequate self-management skills, poor understanding of their chronic illness and failure to engage with adult services. Successful transfer of health care requires the development of self-management skills and increased autonomy. Mobile technology has been proposed as a modality to assist this process. Evidence is limited and generally restricted to illness specific applications. The TransitionMate app (TMApp) is a generic (non-illness specific) mobile application designed to support young people with chronic illness in their transition from paediatric to adult health care services. The overall aim of the study is to assess the effectiveness of TMApp in improving engagement and retention of adolescents with chronic illness within adult healthcare services, as well as preventing the deterioration in illness control and unplanned hospitalisations. METHODS The TransitionMate trial is a dual centre, pragmatic, single arm, mixed methods cohort study conducted within two university teaching tertiary paediatric hospitals in Australia. Data collection points are planned at 0, 6, 12 and 18 months. Outcome indicators include: usage of TransitionMate, engagement with adult services, quantitative markers of illness control, and unplanned hospital admissions. Data are collected through telephone interviews with the participants, their primary healthcare providers, electronic medical records and de-identified mobile application analytics. The development of the application involved co-design with recently transitioned young people with a number of chronic illnesses as well as online user experience in younger adolescents. DISCUSSION The TransitionMate study is the first identified trial of a generic mobile application designed to support adolescents with chronic illnesses during the transition process. Results are expected to provide novel insights into the value of technological tools in the transition space, especially their effectiveness in improving both the transition process and clinical outcomes of adolescents with chronic illnesses. Furthermore, the approach of a pragmatic study design may help identify research methods better designed to overcome inherent challenges in research involving adolescents, transition of care and use of mobile application technology. TRIAL REGISTRATION Registered retrospectively as of 30/1/2020 with Australian New Zealand Clinical Trials Registry: ACTRN12620000074998 .
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Affiliation(s)
- Jeffrey Yeung
- grid.1013.30000 0004 1936 834XThe Clinical School at The Children’s Hospital Westmead, Specialty of Child and Adolescent Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.413973.b0000 0000 9690 854XThe Academic Department of Adolescent Medicine, The Children’s Hospital Westmead, Sydney, Australia
| | - Yisselle I. Virella Pérez
- grid.1013.30000 0004 1936 834XThe Clinical School at The Children’s Hospital Westmead, Specialty of Child and Adolescent Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.413973.b0000 0000 9690 854XThe Academic Department of Adolescent Medicine, The Children’s Hospital Westmead, Sydney, Australia
| | - Shehani C. Samarasinghe
- grid.1013.30000 0004 1936 834XThe Clinical School at The Children’s Hospital Westmead, Specialty of Child and Adolescent Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.413973.b0000 0000 9690 854XThe Academic Department of Adolescent Medicine, The Children’s Hospital Westmead, Sydney, Australia
| | - Vhari Forsyth
- grid.1013.30000 0004 1936 834XThe Clinical School at The Children’s Hospital Westmead, Specialty of Child and Adolescent Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.413973.b0000 0000 9690 854XThe Academic Department of Adolescent Medicine, The Children’s Hospital Westmead, Sydney, Australia
| | - Vathsala Agarwalla
- grid.413973.b0000 0000 9690 854XThe Academic Department of Adolescent Medicine, The Children’s Hospital Westmead, Sydney, Australia
| | - Katharine Steinbeck
- grid.1013.30000 0004 1936 834XThe Clinical School at The Children’s Hospital Westmead, Specialty of Child and Adolescent Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia ,grid.413973.b0000 0000 9690 854XThe Academic Department of Adolescent Medicine, The Children’s Hospital Westmead, Sydney, Australia
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Wang XS, Marani H, Harris‐Taylor C, Drazek L, Rusen J, Farnell N, Lipscombe L, Mukerji G. Quality gaps in care delivery among emerging adults with type 1 diabetes: A retrospective cohort study. Health Sci Rep 2022; 5:e823. [PMID: 36210875 PMCID: PMC9528951 DOI: 10.1002/hsr2.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xinye S. Wang
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Husayn Marani
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Women's College Hospital Institute for Health System Solutions and Virtual CareWomen's College HospitalTorontoOntarioCanada
| | - Cheryl Harris‐Taylor
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Leah Drazek
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Janis Rusen
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Nicola Farnell
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Lorraine Lipscombe
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
- Women's College Research InstituteWomen's College HospitalTorontoOntarioCanada
| | - Geetha Mukerji
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Women's College Hospital Institute for Health System Solutions and Virtual CareWomen's College HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
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Driver D, Berlacher M, Harder S, Oakman N, Warsi M, Chu ES. The Inpatient Experience of Emerging Adults: Transitioning From Pediatric to Adult Care. J Patient Exp 2022; 9:23743735221133652. [PMID: 36311907 PMCID: PMC9597024 DOI: 10.1177/23743735221133652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The pediatric-to-adult care transition has been correlated with worse outcomes,
including increased mortality. Emerging adults transitioning from child-specific
healthcare facilities to adult hospitals encounter marked differences in
environment, culture, and processes of care. Accordingly, emerging adults may
experience care differently than other hospitalized adults. We performed a
retrospective cohort study of patients admitted to a large urban safety net
hospital and compared all domains of patient experience between patients in 3
cohorts: ages 18 to 21, 22 to 25, and 26 years and older. We found that patient
experience for emerging adults aged 18 to 21, and, to a lesser extent, aged 22
to 25, was significantly and substantially worse as compared to adults aged 26
and older. The domains of worsened experience were widespread and profound, with
a 38-percentile difference in overall experience between emerging adults and
established adults. While emerging adults experienced care worse in nearly all
domains measured, the greatest differences were found in those pertinent to
relationships between patients and care providers, suggesting a substantial
deficit in our understanding of the preferences and values of emerging
adults.
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Affiliation(s)
- Daniel Driver
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Daniel Driver, University of Texas
Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390-8811, USA.
| | - Michelle Berlacher
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Department of Pediatrics, Division of Internal Medicine and
Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Stephen Harder
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
| | - Nicole Oakman
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Department of Pediatrics, Division of Internal Medicine and
Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Maryam Warsi
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
| | - Eugene S Chu
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
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Pasquini S, Rinaldi E, Da Prato G, Csermely A, Indelicato L, Zaffani S, Santi L, Sabbion A, Maffeis C, Bonora E, Trombetta M. Growing up with type 1 diabetes mellitus: Data from the Verona Diabetes Transition Project. Diabet Med 2022; 39:e14719. [PMID: 34657317 DOI: 10.1111/dme.14719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
AIM Transition from paediatric to adult care is a critical step in life of emerging adults with type 1 diabetes. We assessed, according to indicators established by panel of experts, clinical, socio-demographic and psychosocial factors in young adults with type 1 diabetes throughout structured transition to investigate the associations, if any, with HbA1c value at time of transition. METHODS The "Verona Diabetes Transition Project" started in January 2009: a structured transition program, shared between paediatric and adult clinic, was organised with a multi-disciplinary team. All young adults underwent a semi-structured interview by a psychologist, before transition. Minimum age for transition was 18 years. RESULTS 222 (M/F = 113/109) young adults moved to adult care from January 2009 to March 2020. The mean time between the last paediatric visit and the first adult visit ranged from 13.6 ± 6.1 months at the beginning of the project to 3.6 ± 11.5 months over the following years. At first adult clinic attendance, women showed higher HbA1c values (70 ± 11 mmol/mol vs. 65 ± 7 mmol/mol or 8.57% ± 1.51% vs. 8.14% ± 0.98%, p = 0.01), higher frequency of disorders of eating behaviours (15.6% vs. 0%, p < 0.001) and poor diabetes acceptance (23.9% vs. 9.7%, p < 0.001) than men. Mediation analyses showed a significant mediating role of glucose control 2 years before transition in the relationship between poor diabetes acceptance and glucose control at transition. CONCLUSIONS This study demonstrated a delay reduction in establishing care with an adult provider and suggested the potential role of low diabetes acceptance on glycemic control at transition. Further studies are needed to confirm and expand these data.
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Affiliation(s)
- Silvia Pasquini
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Giuliana Da Prato
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Csermely
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Liliana Indelicato
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Silvana Zaffani
- Division of Pediatrics, Department of Medicine, University of Verona, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Sabbion
- Division of Pediatrics, Department of Medicine, University of Verona, Verona, Italy
| | - Claudio Maffeis
- Division of Pediatrics, Department of Medicine, University of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University of Verona, Verona, Italy
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Commissariat PV, Wentzell K, Tanenbaum ML. Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance. Diabetes Spectr 2021; 34:328-335. [PMID: 34866865 PMCID: PMC8603129 DOI: 10.2337/dsi21-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Young adults (YAs) are often faced with many new transitions and major milestones specific to their life stage. For YAs with diabetes, it can be particularly difficult to balance diabetes management with the age-typical demands of young adulthood. Clinicians can play an important role in helping YAs navigate major life changes and find balance in the competing demands of young adulthood, while protecting their health and well-being.
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11
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Carreon SA, Duran B, Tang TS, Streisand R, Anderson BJ, Lyons SK, McKay S, Hilliard ME. Here for You: A Review of Social Support Research in Young Adults With Diabetes. Diabetes Spectr 2021; 34:363-370. [PMID: 34866869 PMCID: PMC8603130 DOI: 10.2337/dsi21-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living with and managing diabetes is challenging during young adulthood, and social support may help relieve or minimize the burdens young adults with diabetes experience. This article reviews the types and sources of support young adults with diabetes receive and their associations with behavioral, psychosocial, and glycemic outcomes. Intervention research integrating social support and future directions for care are discussed.
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Affiliation(s)
| | - Brenda Duran
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Tricia S. Tang
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Randi Streisand
- Children’s National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Sarah K. Lyons
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Siripoom McKay
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Marisa E. Hilliard
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
- Corresponding author: Marisa E. Hilliard,
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12
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Relationship between Diabetes Family Conflicts or Problem Recognition in Illness Self-Management and Quality of Life of Adolescents with T1DM and Their Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010710. [PMID: 34682456 PMCID: PMC8535413 DOI: 10.3390/ijerph182010710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the relationship between diabetes family conflicts or problem recognition in illness self-management (PRISM) and the parental perceived quality of life (QoL) of adolescents with type 1 diabetes mellitus (T1DM) and their parents. This was a cross-sectional study, and the participants comprised 111 parents of type 1 diabetes adolescents; data were collected via an online survey and analyzed by descriptive statistics, correlation, and multiple linear regression analysis using the IBM SPSS 25.0 program. The explanatory power of the QoL model in parents of adolescents with T1DM, constructed using three variables—diabetes family conflict (B = −0.56), regimen pain and bother (B = −11.25), and peer interactions (B = −7.48), which are PRISM barriers—was 35.7% (F = 5.70, p < 0.001). Diabetes family conflicts (B = −0.86) and peer interactions (B = −9.04) explained 57.3% of the variance in the parental perceived QoL of adolescents with T1DM (F = 12.33, p < 0.001). In order to improve the QoL in parents and adolescents with type 1 diabetes, interventions to effectively manage diabetes family conflicts and improve peer interactions are necessary.
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13
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Sauder KA, Stafford JM, Ehrlich S, Lawrence JM, Liese AD, Marcovina S, Mottl AK, Pihoker C, Saydah S, Shah AS, D'Agostino RB, Dabelea D. Disparities in Hemoglobin A 1c Testing During the Transition to Adulthood and Association With Diabetes Outcomes in Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2021; 44:dc202983. [PMID: 34376501 PMCID: PMC8929181 DOI: 10.2337/dc20-2983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify correlates of hemoglobin A1c (HbA1c) testing frequency and associations with HbA1c levels and microvascular complications in youth-onset diabetes. RESEARCH DESIGN AND METHODS The SEARCH for Diabetes in Youth study collected data from individuals diagnosed with diabetes before age 20 at 8 years (n=1,885 type 1, n=230 type 2) and 13 years (n=649 type 1, n = 84 type 2) diabetes duration. We identified correlates of reporting ≥3 HbA1c tests/year using logistic regression. We examined associations of HbA1c testing with HbA1c levels and microvascular complications (retinopathy, neuropathy, or nephropathy) using sequentially adjusted linear and logistic regression. RESULTS For type 1 diabetes, odds of reporting ≥3 HbA1c tests/year at 8 and 13 years diabetes duration decreased with older age at diagnosis (odds ratio [OR] 0.91 [95% CI 0.88-0.95]), longer duration of diabetes (OR 0.90 [0.82-0.99]), not having a personal doctor (OR 0.44 [0.30-0.65]), and lapses in health insurance (OR 0.51 [0.27-0.96]). HbA1c testing ≥3 times/year over time was associated with lower HbA1c levels (OR -0.36% [-0.65 to -0.06]) and lower odds of microvascular complications (OR 0.64 [0.43-0.97]) at 13 years duration, but associations were attenuated after adjustment for HbA1c testing correlates (OR -0.17 [-0.46 to 0.13] and 0.70 [0.46-1.07], respectively). For type 2 diabetes, not seeing an endocrinologist decreased the odds of reporting ≥3 HbA1c tests/year over time (OR 0.19 [0.06-0.63]), but HbA1c testing frequency was not associated with HbA1c levels or microvascular complications. CONCLUSIONS We observed disparities in HbA1c testing frequency predominately by health care-related factors, which were associated with diabetes outcomes in type 1 diabetes.
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Affiliation(s)
- Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shelley Ehrlich
- Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC
| | - Santica Marcovina
- Northwest Lipid Research Laboratory, University of Washington, Seattle, WA
| | - Amy K Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amy S Shah
- Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
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14
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Hickling A, Dingle GA, Barrett HL, Cobham VE. Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes. J Pediatr Psychol 2021; 46:1091-1109. [PMID: 34313769 DOI: 10.1093/jpepsy/jsab052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). METHODS A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. RESULTS A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. CONCLUSIONS Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.
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Affiliation(s)
- Anna Hickling
- School of Psychology, The University of Queensland.,Mater Research Institute, The University of Queensland.,Children's Hospital Foundation (Queensland)
| | | | - Helen L Barrett
- Mater Research Institute, The University of Queensland.,Department of Endocrinology, Mater Health Services, Mater Hospital
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland.,Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service
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15
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Zaidi R. Transitional care in diabetes: a quest for the Holy Grail. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Reza Zaidi
- MBBS, FRCP, Consultant Diabetologist, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Transition Lead – North West England Children and Young People Diabetes Network
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16
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Chiang YT, Yu HY, Lo FS, Chen CW, Huang TT, Chang CW, Moons P. Emergence of a butterfly: the life experiences of type 1 diabetes Taiwanese patients during the 16-25 years old transition period. Int J Qual Stud Health Well-being 2020; 15:1748362. [PMID: 32292126 PMCID: PMC7178814 DOI: 10.1080/17482631.2020.1748362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose: To explore the life experiences of patients with type 1 diabetes transition from adolescence into adulthood in Taiwan.Methods: Descriptive phenomenological design was used. Fourteen participants were individually interviewed using a semi-structured interview.Results: The life experiences of patients with type 1 diabetes transition from adolescence into adulthood experience a metamorphosis from awareness of responsibility to figuring out a way to care for themselves. Six themes emerged: (1) hibernation: awareness of responsibility; (2) emergence: attempts to take responsibility; (3) perseverance: encountering difficulties; (4) anxiety: multiple worries; (5) hesitation: back-and-forth," and (6) exit: finding a way out."Conclusions: During the transition phase, the participants experienced the trials of various situations. Regardless of whether they are able to independently bear the responsibilities of self-management, they all hope to turn around the challenges of disease control and take ownership of their disease. Like a butterfly that emerges from a cocoon, they hoped to overcome the dangers of taking flight through trial and error and navigating the world. The results of this study can serve as a reference for clinical care and developing localized intervention strategies targeted to the transition period between adolescence and young adulthood.
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Affiliation(s)
- Yueh-Tao Chiang
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Hsing-Yi Yu
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan
- Department of Nursing, Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Fu-Sung Lo
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang- Gung Memorial Hospital, Tao-yuan, Taiwan
- College of Medicine, Chung-Gung University, Tao-yuan, Taiwan
| | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Ting Huang
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan
- Department of Neurology (Dementia Center), Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Tao-yuan, Taiwan
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Tao-yuan, Taiwan
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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17
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Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study. Diabetes Care 2020; 43:2469-2477. [PMID: 32778555 PMCID: PMC7510035 DOI: 10.2337/dc20-0760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the relationship between health care coverage and HbA1c in young adults with youth-onset type 2 diabetes who transitioned to community diabetes care after receiving care during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS Participants completed questionnaires annually. HbA1c was measured in a central laboratory. Data from 2 years before and after transitioning to community care (2013-2016) were examined and compared between states with and without expanded Medicaid. RESULTS In 2016 (n = 427; mean age 24 years), 2 years after transitioning to community care, 93% of participants in states with Medicaid expansion had health care coverage compared with 68% (P < 0.0001) in states without Medicaid expansion. Mean HbA1c was 9.8% in participants with government coverage, 9.3% with commercial coverage, and 10.1% in those with no coverage (P = 0.0774). Additionally, 32%, 42%, and 66% of those with government coverage, commercially covered, and no coverage, respectively, were not attending outpatient diabetes visits (P < 0.0001). Of those with government coverage, 83% reported they had adequate coverage for insulin syringes/needles/pens, and 89% for glucose-monitoring supplies, with more limited coverage in those with commercial plans. Participants with commercial coverage had higher education attainment (P < 0.0001); 52% had HbA1c ≥9.0% compared with 64% of those who were government covered and 58% with no coverage (P = 0.0646). CONCLUSIONS More young adults with type 2 diabetes from the TODAY cohort had health care coverage in states with expanded Medicaid but glycemic control remained poor, regardless of coverage. New therapies and approaches are needed for this vulnerable population.
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Chronic illness and transition from paediatric to adult care: a systematic review of illness specific clinical guidelines for transition in chronic illnesses that require specialist to specialist transfer. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractIntroductionA quarter of a century has passed since the importance of transition from paediatric to adult care for chronically ill adolescents was highlighted by the American Society of Adolescent Health and Medicine. Despite discussions, the development of generic guidelines and some cohorting of age groups in paediatric speciality care, adolescents continue, unacceptably, to fall through the care gaps with negative clinical outcomes. Government bodies and international organisations have developed clinical practice guidelines (CPGs) for specific chronic physical illness although it remains unclear as to what extent these discuss transition from paediatric to adult care. This study systematically reviewed scientific and grey literature to determine how effectively transition has been incorporated into chronic illness specific CPGs.MethodsFive bibliographical databases; Medline, Embase, PsycINFO, CINAHL and Web of Science plus an extensive grey literature search from the internet were used to identify published guidelines between 2008 and 2018 using key words adolescents, transition, guidelines, together with the names of over 20 chronic physical illnesses which require specialist to specialist care after transitioning from paediatric care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. In addition a measure of trustworthiness for CPGs was included. Guidelines were benchmarked against a published set of Australian transition principles embodying the comprehensive recommendations from National Institute for health and Care Excellence (NICE) transition guidelines discussing key transition aspects on: a systematic and formal transition process; early preparation; transition coordinators, good communication and collaboration between health professionals; individualised transition plan, enhancing self-management and active follow up after transition.ResultsInitially, 1055 articles were identified from the literature searches. Eight hundred and sixty eight articles were selected for title and abstract review. One hundred and seventy eight articles were included for full text review. Ultimately, 25 trustworthy CPGs were identified and included across 14 chronic physical illnesses. Five articles exclusively discussed illness specific transition recommendations and two included all the seven key transition principles. Three provided a minimal discussion of transition to adult care due to lack of high level evidence. Follow up and evaluation was the least addressed principle with recommendations in only seven CPGs.ConclusionsA limited number of chronic physical illnesses have illness specific CPGs that address transition from paediatric to adult care. The CPGs’ content emphasises the need for empirical data in order to develop quality transition recommendations for adolescents with chronic physical illness to ensure long term engagement and retention within health services.
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19
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Butalia S, McGuire KA, Dyjur D, Mercer J, Pacaud D. Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study. Health Sci Rep 2020; 3:e181. [PMID: 32782975 PMCID: PMC7410016 DOI: 10.1002/hsr2.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective. METHODS We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post-transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed. RESULTS Three focus groups were conducted: pre-transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post-transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support. CONCLUSION This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- O'Brien Institute for Public Health, Cumming School of Medicine, CalgaryUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Ashlee McGuire
- Provincial Primary Health CareAlberta Health ServicesCalgaryAlbertaCanada
- Department of Family Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David Dyjur
- Diabetes Centre CalgaryAlberta Health ServicesCalgaryAlbertaCanada
| | - Julia Mercer
- Alberta Children's Hospital, Diabetes ClinicAlberta Health ServicesCalgaryAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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20
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James S, Perry L, Gallagher R, Lowe J. A discussion of healthcare support for adolescents and young adults with long-term conditions: Current policy and practice and future opportunities. Int J Nurs Pract 2020; 26:e12882. [PMID: 32812309 DOI: 10.1111/ijn.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescence and young adulthood can be a period of significant and unique life changes in which competing demands and challenges distract from disease self-management. Specific challenges related to the way individual services are configured can also limit the support available. This paper presents a discussion of healthcare service support for adolescents and young adults, using type 1 diabetes as an exemplar. DESIGN Discussion paper. RESULTS A wide variety of issues at the biopsychosocial level of the individual, health services policy and practice pose challenges to effective health support for adolescents and young adults. Intersectoral, multilevel and multicomponent opportunities are available to engage and empower young people to be part of change and accountability mechanisms and to transform the support available and outcomes achievable. A priority research agenda can benefit patients, families and their communities. CONCLUSION Future policy and practice development may assist clinicians, service providers and managers, policymakers, non-governmental organizations and community groups to deliver more effective and efficient support to vulnerable adolescent and young adult populations.
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Affiliation(s)
- Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Julia Lowe
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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21
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Band ME. Sugar Babies. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Shulman R, Fu L, Knight JC, Guttmann A, Chafe R. Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study. CMAJ Open 2020; 8:E69-E74. [PMID: 32046971 PMCID: PMC7012632 DOI: 10.9778/cmajo.20190019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transition to adult diabetes care is a high-risk period for acute complications, yet the optimal transition care model is unknown. To gain insight into the impact on health outcomes of system-level transition processes that reflect resourcing differences, we examined acute complications in youth with diabetes across transition in 2 Canadian provinces with different transition care models. METHODS We used linked provincial health administrative data for Ontario and Newfoundland and Labrador to create 2 parallel cohorts of youth with diabetes diagnosed before age 15 years who turned 17 between 2006 and 2011. Participants were followed until 2015 (maximum age 21 yr). We described rates of and proportion of participants with at least 1 diabetes-related hospital admission at age 15-17 years and 18-20 years, standardized according to material deprivation based on the 2006 Canadian Marginalization Index. We compared diabetes-related admissions at age 15-17 years and 18-20 years in the Ontario cohort. RESULTS The cohorts consisted of 2525 youth in Ontario and 93 in Newfoundland and Labrador. In Newfoundland and Labrador, 39 participants (42.0%) were in the lowest socioeconomic quintile, versus 326 (12.9%) in Ontario. The standardized rate of diabetes-related hospital admissions per 100 person-years was 13.5 (95% confidence interval [CI] 12.6-14.4) at age 15-17 years and 14.4 (95% CI 13.5-15.3) at age 18-20 years in Ontario, and 11.4 (95% CI 7.0-15.8) at age 15-17 years and 10.5 (95% CI 6.4-14.6) at age 18-20 years in Newfoundland and Labrador. In Ontario, there was no association between the rate (adjusted rate ratio 1.10, 95% CI 0.94-1.28) or occurrence (adjusted odds ratio 1.03, 95% CI 0.91-1.17) of diabetes-related admissions across transition. INTERPRETATION Although posttransition care is delivered differently in the 2 provinces, rates of adverse events across transition were stable in both. Coordinated support during transition is needed to help mitigate adverse events for young adults in both provinces. Delivery of other health care and social services, including primary care, may be influencing the risk of adverse events after transition to adult care.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld.
| | - Longdi Fu
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
| | - John C Knight
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
| | - Astrid Guttmann
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
| | - Roger Chafe
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
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Martyn-Nemeth P, Duffecy J, Quinn L, Park C, Mihailescu D, Penckofer S. A cognitive behavioral therapy intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes (FREE): study protocol for a randomized controlled trial. Trials 2019; 20:796. [PMID: 31888691 PMCID: PMC6938021 DOI: 10.1186/s13063-019-3876-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/02/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In persons with type 1 diabetes (T1D), hypoglycemia is the major limiting factor in achieving optimal glycemic control. All persons with T1D are at risk for hypoglycemia (blood glucose level < 70 mg/dl), which is life-threatening and accompanied by serious physical and psychological symptoms, resulting in profound fear of hypoglycemia (FOH) and reduced quality of life. Young adults with T1D are at risk for FOH and have worse glycemic control and self-management behavior than other age groups with T1D. FOH also results in increased glycemic variability (GV). A major gap exists in how to manage FOH. Our overall objective is to reduce FOH and improve diabetes self-management, glycemic control, and GV in young adults with T1D to reduce or delay diabetes complications and improve quality of life. We aim to (1) determine the feasibility and acceptability of an eight-week cognitive behavioral therapy (CBT)-based Fear Reduction Efficacy Evaluation (FREE) intervention in young adults with T1D who experience FOH; and (2) determine the impact of the FREE intervention, compared to an attention control group, on the outcomes FOH, self-management, glycemic control (A1C), and glycemic variability (continuous glucose monitoring recordings). METHODS/DESIGN A randomized controlled trial in 50 young adults aged 18 to 35 years with T1D will be used. Eligible subjects will be randomized to the intervention program (Fear Reduction Efficacy Evaluation [FREE]) or attention control group. A one-week run-in phase is planned, with baseline measures of FOH, self-management behavior, A1C, and real-time continuous glucose monitoring recordings (RT-CGM) to calculate GV for both groups. The intervention group will participate in eight weekly individual one-hour sessions using CBT and exposure treatment for specific fears. RT-CGM and a daily FOH diary will be used as feedback cues as part of the FREE program. The attention control group will participate in eight weekly individual one-hour diabetes self-management education (DSME) sessions and wear a RT-CGM device (to measure GV only) over 8 weeks. At completion, FOH will be measured, and RT-CGM recordings will be analyzed to determine differences between the FREE and control groups. DISCUSSION Findings from this proposed pilot study will serve as the foundation for a larger trial to reduce FOH and improve self-management, glycemic control, and GV. TRIAL REGISTRATION ClinicalTrials.gov: A cognitive behavioral therapy (CBT) intervention to reduce fear of hypoglycemia in type 1 diabetes, NCT03549104. Registered June 7, 2018.
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Affiliation(s)
- Pamela Martyn-Nemeth
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL, 60612, USA.
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Laurie Quinn
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, 845 South Damen Avenue (MC 802), Chicago, IL, 60612, USA
| | - Chang Park
- Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Dan Mihailescu
- Endocrinology/Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Johnson B, Norman P, Sanders T, Elliott J, Whitehead V, Campbell F, Hammond P, Ajjan R, Heller S. Working with Insulin, Carbohydrates, Ketones and Exercise to Manage Diabetes (WICKED): evaluation of a self-management course for young people with Type 1 diabetes. Diabet Med 2019; 36:1460-1467. [PMID: 31295354 DOI: 10.1111/dme.14077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
AIMS To evaluate a 5-day self-management education course for young people with Type 1 diabetes and assess its effects on knowledge, self-efficacy, beliefs, distress, self-management behaviours and HbA1c . METHODS This is an evaluation of a structured education course. Young people (aged 16-24 years) with Type 1 diabetes were recruited from three diabetes centres. In the first centre, participants completed self-report measures of knowledge, self-efficacy, positive and negative outcome expectancies, and hypoglycaemic worries at baseline (n=47) and the end of the course (n=42). In two additional centres, participants completed these and other measures assessing self-management behaviours, cognitive adaptation to diabetes and diabetes distress at baseline (n=32), the end of the course (n=27) and 3-month follow-up (n = 27). HbA1c levels were recorded at baseline (n=79), 6 months (n=77) and 12 months (n=65). RESULTS There were statistically significant increases in self-report knowledge, self-efficacy, positive outcome expectancies and self-management behaviours, and a statistically significant decrease in negative outcome expectances, between baseline and the end of the course. There were also statistically significant increases in self-report knowledge, self-efficacy, self-management behaviours and cognitive adaptation to diabetes between baseline and 3-month follow-up. Compared with baseline, HbA1c levels decreased by a mean (sd) of 5.44 (19.93) mmol/mol (0.48%) at 6 months (P=0.019), and by 5.98 (23.32) mmol/mol (0.54%) at 12 months (P =0.043). DISCUSSION The results indicate the potential benefits of a self-management course designed to address the developmental needs and challenges faced by young people with Type 1 diabetes. Further studies with larger numbers and appropriate controls are required to confirm these initial findings.
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Affiliation(s)
- B Johnson
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - P Norman
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - T Sanders
- Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - J Elliott
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
| | - V Whitehead
- Diabetes Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - F Campbell
- Children's Diabetes Centre, Leeds Children's Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - P Hammond
- Diabetes Resource Centre, Harrogate District Hospital, Harrogate, UK
| | - R Ajjan
- Division of Cardiovascular and Diabetes Research, Leeds Institute for Genetics, Health and Therapeutics, Leeds, UK
| | - S Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
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Kim G, Choi EK, Kim HS, Kim H, Kim HS. Healthcare Transition Readiness, Family Support, and Self-management Competency in Korean Emerging Adults with Type 1 Diabetes Mellitus. J Pediatr Nurs 2019; 48:e1-e7. [PMID: 30929981 DOI: 10.1016/j.pedn.2019.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/16/2019] [Accepted: 03/16/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The current study investigated factors related to healthcare transition readiness, including family support and self-management competency, in emerging adults with Type 1 diabetes mellitus (T1DM). DESIGN AND METHODS A cross-sectional survey was conducted with 87 individuals, aged 16-24 years. Participants were recruited both from the outpatient clinic of Severance Children's Hospital, and an online self-help group for emerging adults with T1DM in South Korea. Participants reported perceived levels of family support, self-management competency, and healthcare transition readiness through a structured questionnaire. RESULTS Healthcare transition readiness was positively correlated with family support (r = 0.257, p = .016) and self-management competency (r = 0.606, p < .001). Multivariate linear regression analyses revealed that only self-management competency was a significant factor associated with healthcare transition readiness (β = 0.699, p < .001). CONCLUSIONS For emerging adults with T1DM, ongoing family involvement in diabetes care and enhanced self-management competency can strengthen their healthcare transition readiness. Furthermore, primary factors associated with healthcare transition readiness in the present study were identified as self-management competency and participants' age. PRACTICE IMPLICATIONS Healthcare providers should assess and enhance healthcare transition readiness in emerging adults with T1DM. A primary method of addressing transition readiness is helping people strengthen their self-management competency.
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Affiliation(s)
- Gayeong Kim
- Yonsei University College of Nursing, Republic of Korea
| | - Eun Kyoung Choi
- Yonsei University College of Nursing, Republic of Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea.
| | - Hee Soon Kim
- Yonsei University College of Nursing, Republic of Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea
| | - Heejung Kim
- Yonsei University College of Nursing, Republic of Korea; Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Republic of Korea
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Ramchandani N, Way N, Melkus GD, Sullivan-Bolyai S. Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2019; 45:484-497. [PMID: 31304878 DOI: 10.1177/0145721719861349] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored. METHODS A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected. RESULTS The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM. CONCLUSIONS The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.
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Affiliation(s)
| | - Niobe Way
- Department of Applied Psychology, New York University Steinhardt, New York, New York
| | | | - Susan Sullivan-Bolyai
- University of Massachusetts Medical School-Graduate School of Nursing, Worcester, Massachusetts
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27
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Lee H, Choi EK, Kim H, Kim HS, Kim HS. [Factors Affecting the Self-Management of Adolescents with Type 1 Diabetes Mellitus based on the Information-Motivation-Behavioral Skills Model]. CHILD HEALTH NURSING RESEARCH 2019; 25:234-243. [PMID: 35004416 PMCID: PMC8650926 DOI: 10.4094/chnr.2019.25.2.234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/23/2019] [Accepted: 03/23/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate associations between self-management and diabetes knowledge, diabetesrelated attitudes, family support, and self-efficacy in adolescents with type 1 diabetes mellitus based on the information-motivation- behavior skills model. METHODS Data collection was conducted between March 18 and September 30, 2018. Patients (N=87) aged 12 to 19 years were recruited from the outpatient clinic of S children's hospital and an online community for patient with type 1 diabetes mellitus. Data were analyzed using descriptive statistics, the independent t-test, one-way ANOVA, Pearsons correlation, and hierarchical multiple linear regression with SPSS IBM 23.0, with the two-tailed level of significance set at 0.05. RESULTS The mean score of self-management in adolescents with type 1 diabetes mellitus was 61.23±10.00 out of 80. The regression analysis showed that self-efficacy and family support significantly explained 56.9% of the variance in self-management (F=21.38, p<.001). Self-efficacy (β=.504, p<.001) and family support (β=.188, p<.001) were significant predictors of self-management. CONCLUSION It is necessary to develop individual interventions to improve self-efficacy and family support for adolescents with type 1 diabetes mellitus to help them enhance their self-management.
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Affiliation(s)
| | - Eun Kyoung Choi
- Corresponding author Eun Kyoung Choi https://orcid.org/0000-0003-4622-2437 College of Nursing, Yonsei University 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea TEL +82-2-2228-3340 FAX +82-2-392-5440 E-MAIL
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Iversen E, Kolltveit BCH, Hernar I, Mårtensson J, Haugstvedt A. Transition from paediatric to adult care: a qualitative study of the experiences of young adults with type 1 diabetes. Scand J Caring Sci 2019; 33:723-730. [PMID: 30866071 DOI: 10.1111/scs.12668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
AIM The aim of the present study was to explore how young adults with type 1 diabetes (T1D) experienced the transition from paediatric to adult health care services. DESIGN A qualitative, explorative design was used. METHODS Eleven young adults with T1D receiving adult diabetes care at a hospital in western Norway participated in semi-structured interviews. Data were analysed using Interpretive Description, an inductive approach inspired by grounded theory, ethnography and phenomenology, and specifically designed to explore phenomena in clinical practice aiming to generate new knowledge and skills. RESULTS Four main themes regarding the adolescents' experiences of the transfer from paediatric to adult care emerged: (i) limited information about the transition; (ii) transition from frequent, thorough and personal follow-up to a less comprehensive and less personal follow-up; (iii) the importance of being seen as a whole person; (iv) limited expectations of how the health care services were organised. CONCLUSIONS The study showed that the existing routines for transfer between paediatric and adult care are not optimal. The participants expressed that they were not prepared for the dissimilarities in follow-up and were predominantly less pleased with the adult care follow-up. RELEVANCE TO CLINICAL PRACTICE The findings support a need for structured transition programmes, that is programmes that contribute to young adults with T1D receiving a safe and positive transition at an otherwise demanding life phase. Young peoples' individual needs for the transition to and follow-up in adult care may be promoted by an approach based on person-centred care.
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Affiliation(s)
- Elisabeth Iversen
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Ingvild Hernar
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jan Mårtensson
- Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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29
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Burns K, Farrell K, Myszka R, Park K, Holmes-Walker DJ. Access to a youth-specific service for young adults with type 1 diabetes mellitus is associated with decreased hospital length of stay for diabetic ketoacidosis. Intern Med J 2018; 48:396-402. [PMID: 29034986 DOI: 10.1111/imj.13649] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/27/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Management of type 1 diabetes mellitus in youth with diabetes (YWD) is complex, and glycaemic control often deteriorates during this challenging period. We hypothesise that attendance at a youth-specific diabetes clinic reduces hospital admission rates and length of stay (LOS) for diabetic ketoacidosis (DKA). AIMS To assess the impact of a youth-specific diabetes service for YWD on DKA admissions in two adjacent local health districts. METHODS A retrospective cohort analysis of admissions for DKA in YWD aged 15-25 years, presenting to four hospitals in Western Sydney in 2011 was performed. Number of admissions, LOS and DKA severity were assessed. Cost was analysed as a function of LOS. Groups were divided by attendance at a youth-specific diabetes service and no record of attendance. RESULTS There were 55 DKA admissions from 39 patients (median age 20.0 years); the majority of admissions (82%) was YWD not supported by a youth-specific diabetes service. Median LOS was significantly longer in the unsupported group (3.0 vs 1.5 days, P = 0.028). Median pH at presentation in the unsupported group was significantly lower, 7.11 versus 7.23 (P = 0.05). The admission rate was four times greater for those not supported by youth-specific diabetes services, 5.5% compared with 1.6% (P = 0.001). The estimated cost saved by youth-specific services was over $250,000 pa. CONCLUSIONS Lack of access to supported care for YWD during transition from paediatric to adult care has an adverse impact on subsequent DKA admission rates and LOS.
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Affiliation(s)
- Kharis Burns
- Diabetes Transition Support Program, Department Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kaye Farrell
- Diabetes Transition Support Program, Department Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rickie Myszka
- Diabetes Transition Support Program, Department Diabetes and Endocrinology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Kris Park
- Diabetes Transition Support Program, Department Diabetes and Endocrinology, Nepean Hospital, Sydney, New South Wales, Australia
| | - D Jane Holmes-Walker
- Diabetes Transition Support Program, Department Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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30
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Gallwitz B, Neu A. [Diabetes mellitus at the interface between pediatric and adult medicine]. Internist (Berl) 2018; 59:1133-1137. [PMID: 30229365 DOI: 10.1007/s00108-018-0497-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Patients with chronic diseases manifesting in childhood, such as type 1 diabetes, need to make an optimal transition from pediatric to adult medical care. This or transitionis a challenge for patients and their treatment teams, since metabolic control is often unstable at this time of life. Additional factors like the social environment, as well as concomitant diseases, also need to be taken into account and often represent hurdles to optimal therapy. Transition is an important process to guarantee good self-management of diabetes therapy and good outcomes in the long term. This review provides an overview and recommendations on the topic of transition in diabetes.
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Affiliation(s)
- B Gallwitz
- Medizinische Klinik IV, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - A Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, Wolfsdorf JI, Schatz D. Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care 2018; 41:2026-2044. [PMID: 30093549 PMCID: PMC6105320 DOI: 10.2337/dci18-0023] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jane L Chiang
- McKinsey & Company and Diasome Pharmaceuticals, Inc., Palo Alto, CA
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Katharine C Garvey
- Division of Endocrinology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Stuart A Weinzimer
- Pediatric Endocrinology & Diabetes, Yale School of Medicine, New Haven, CT
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Desmond Schatz
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
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Abstract
PURPOSE OF REVIEW This review summarizes the literature on care and outcome disparities in young adults (YA) with type 1 and type 2 diabetes, and outlines remaining needs and suggestions to reduce disparities and improve care. RECENT FINDINGS Despite well-documented disparities and data from large national and international diabetes populations, the role that social determinants of health play in disease management is largely unstudied. Further, mechanisms of how these risk factors interact with the unique developmental needs of racial-ethnic minority and economically vulnerable young adults with diabetes remain unknown. Little intervention research has focused on improving outcomes in this vulnerable population. More research needs to focus on identifying and addressing risk factors in racial-ethnic minority and economically vulnerable young adults with diabetes. Interventions need to be adapted and developed to meet the unique needs of this high-risk population. Clinicians and healthcare systems must recognize the inequity in care and outcomes for this group and structure clinical programs and policies to promote their optimal care.
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Affiliation(s)
- Shivani Agarwal
- Endocrinology, Diabetes, and Metabolism, University of Pennsylvania, Smilow Translational Research Center Room 12-142 3400 Civic Center Blvd., Philadelphia, PA, USA.
| | - Marisa Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
| | - Ashley Butler
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
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Hyperglycemia in Young Adults With Types 1 and 2 Diabetes Seen in the Emergency Department: A Health Records Review. Can J Diabetes 2018; 42:296-301.e5. [DOI: 10.1016/j.jcjd.2017.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
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Caring for urologic transition patients: Current practice patterns and opinions. J Pediatr Urol 2018; 14:242.e1-242.e5. [PMID: 29559274 DOI: 10.1016/j.jpurol.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/03/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Congenitalism is an emerging field that recognizes the complex needs of adult patients with congenital urologic issues. Despite the onset of transitional care clinics, these patients remain difficult to care for due to resource availability, insurance coverage, and multi-disciplinary needs. OBJECTIVE The current study sought to characterize practice patterns and opinions regarding care for urologic transition patients. DESIGN An anonymous 20-question survey was sent to members of the Society of Pediatric Urology listserv. Questions pertained to physician background, practice demographics, clinic structure, and quality. Five-point Likert scales were used to assess quality markers (5 = most/best). Data were analyzed in R, and subgroup analyses were performed. Subgroups included presence of formal transition clinic, city size, and practice type. RESULTS The response rate was 53%, with 124 respondents. A formal transition clinic was reported by 32%. Those with formal clinics reported higher enthusiasm (3.9 vs 3.4, P < 0.01) for care of these patients and believed they provided better care compared to other institutions (P < 0.001) Summart Table. There was no significant difference in perceived quality between respondents in academic vs other practices. There was a small trend towards higher-quality ratings in smaller cities (3.8 vs 3.5, P = 0.13). The majority (64%) felt that transition patients are best cared for by specialized adult providers; however, these formalized clinics found to be staffed primarily by pediatric providers (54%). DISCUSSION This study supported the general consensus in the literature that transition clinics improve care for urologic transition patients, while underlining discordance between current practice patterns and recommendations for optimal care. CONCLUSION The majority of practices appeared to lack a formal transition clinic, and there was variation in their structure. Those with formal clinics tended to rate themselves as providing higher-quality care. The majority of respondents believed that adult specialists in either reconstructive or neuro-urology are best suited to care for these complex patients.
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The genesis of systems of care for transition to adulthood services: emerging models in primary and subspecialty care. Curr Opin Pediatr 2018; 30:303-310. [PMID: 29406441 DOI: 10.1097/mop.0000000000000608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transitioning adolescents and young adults with chronic conditions can be complex. Expert recommendations support a transition process that starts in early adolescence, provides continuous guidance and support and allows for care opportunities with patients and caregivers, with the patient alone and between paediatric and adult providers. As most of the guidance is focused on individual patients, providers and clinical programmes, much less is known about how health systems as a whole might support effective transitions of care. RECENT FINDINGS Many intervention studies focus on the preparation necessary to successfully transition adolescents, young adults and their families to adult care. Although randomized controlled trials of transition interventions are few and standards of care not yet established, promising models are being developed and tested. This review will describe the development and implementation of emerging models of transitional care in primary and subspecialty care, paying special attention to evaluation outcomes that can inform model selection. SUMMARY The emerging models described here highlight the importance of and guidance for invested clinicians and health systems to create effective methods for successful transition. Additional research using rigorous methodology is necessary.
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Zoni S, Verga ME, Hauschild M, Aquarone-Vaucher MP, Gyuriga T, Ramelet AS, Dwyer AA. Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care. J Pediatr Nurs 2018; 38:99-105. [PMID: 29357987 DOI: 10.1016/j.pedn.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. DESIGN AND METHODS A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations. RESULTS Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. CONCLUSIONS Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition. PRACTICE IMPLICATIONS Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.
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Affiliation(s)
- Sandra Zoni
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
| | - Marie-Elise Verga
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Haute école de santé Fribourg, Fribourg Switzerland
| | - Michael Hauschild
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Marie-Paule Aquarone-Vaucher
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Teresa Gyuriga
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Department of Maternal and Child Health, Lausanne, Switzerland
| | - Andrew A Dwyer
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Endocrinology, Diabetes and Metabolism Service, Lausanne, Switzerland.
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Alassaf A, Gharaibeh L, Grant C, Punthakee Z. Predictors of type 1 diabetes mellitus outcomes in young adults after transition from pediatric care. J Diabetes 2017; 9:1058-1064. [PMID: 28177592 DOI: 10.1111/1753-0407.12536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/03/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a common chronic disease. Poor health outcomes are often noted after transfer to adult health care. It is important to determine the predictors of such outcomes to decrease morbidity and mortality. METHODS The present retrospective study included patients followed for ≥1 year before and ≥1 year after transfer to adult care in a Canadian tertiary diabetes center. Data including demographics, education, comorbidity and pediatric diabetes management-related factors were analyzed as possible independent predictors of adult HbA1c, number of adult diabetes-related hospitalizations, and clinic visits. RESULTS In all, 102 youths were followed to a mean (±SD) age of 21.8 ± 1.5 years. Predictors of mean adult HbA1c using linear regression were the presence of any comorbidity (0.71%; 95% confidence interval [CI] 0.15-1.27; P = 0.01) and pediatric HbA1c (0.67% per 1% increase in HbA1c; 95% CI 0.51-0.84; P < 0.001). Predictors of hospitalization for hyperglycemia were a history of pediatric hospitalization for hyperglycemia (incidence rate ratio [IRR] 1.20; 95% CI 1.02-1.41; P = 0.029) and high school vs university education (IRR 3.13; 95% CI 1.12-8.73; P = 0.030). CONCLUSION Young adults with complicated health histories and less education are more likely to experience poor diabetes outcomes in the years after transfer to adult care. These features may highlight youth requiring closer attention or may be targets for intervention.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lubna Gharaibeh
- Department of Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Christina Grant
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ng AH, Crowe TC, Ball K, Rasmussen B. Transitional Needs of Australian Young Adults With Type 1 Diabetes: Mixed Methods Study. JMIR Diabetes 2017; 2:e29. [PMID: 30291076 PMCID: PMC6238857 DOI: 10.2196/diabetes.8315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young adulthood is marked by transitions that impact diabetes self-management behaviors, which require ongoing diabetes education and support. Traditional diabetes education programs and services currently do not meet the needs of many young adults with type 1 diabetes mellitus (T1DM) as they continue to fall through the cracks of clinical services. Age-centered diabetes education programs and services present an opportunity for young adults to meet in a supportive environment and gain a better understanding about diabetes management. OBJECTIVE The aim of the study was to identify the health and well-being needs of Australian young adults aged between 18 and 35 years with T1DM to develop appropriate solutions to keep them engaged with diabetes self-management. METHODS In total, 13 semistructured individual interviews and self-reported surveys were obtained to understand participants' experiences with diabetes education programs and services. Together with survey data, transcribed interviews were analyzed into themes and categories using comparative analysis to identify the health and well-being needs of young adults with T1DM during young adulthood. RESULTS Diabetes education and service needs for young adults with T1DM related to improving access to existing diabetes education programs and services, having credible informational resources, as well as having personalized diabetes management advice. Participants especially valued relevant and real-time information and opportunities for peer support, mostly sourced from Web-based platforms. CONCLUSIONS There is a need for diabetes education programs and services to be age-appropriate and easily accessible, to provide relevant and credible information, and to provide opportunities for peer support to better support young adults with T1DM. These findings also support the use of diabetes education programs or services delivered online through mHealth systems in this population.
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Affiliation(s)
- Ashley H Ng
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Timothy C Crowe
- School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Bodil Rasmussen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
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Hansen KK, Jensen AL. Partnership in transition: Experiences of adolescents with Type 1 diabetes. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/20573316.2017.1382182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karina Kudahl Hansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Annesofie Lunde Jensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
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Buschur EO, Glick B, Kamboj MK. Transition of care for patients with type 1 diabetes mellitus from pediatric to adult health care systems. Transl Pediatr 2017; 6:373-382. [PMID: 29184818 PMCID: PMC5682376 DOI: 10.21037/tp.2017.09.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Planning for the transition from pediatric to adult healthcare is broadly understood to be beneficial to the quality of care of patients with chronic illness. Due to the level of self-care that is necessary in the maintenance of most chronic diseases, it is important that pediatric settings can offer support during a time when adolescents are beginning to take more responsibility in all areas of their lives. Lack of supportive resources for adolescents with chronic conditions often results in both decreased access to care and impaired health and function likely leading to increased medical costs later. Additionally, fundamental differences in health care delivery exist between pediatric and adult care settings. There is limited empiric data and information on best practices in transition care. In this article we address the importance of bridging pediatric and adult care settings and highlight the challenges and successes of the implementation of the young adult transition clinic program for patients with type 1 diabetes at our facility. We provide recommendations for further research and program implementation with the transition population.
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Affiliation(s)
- Elizabeth O Buschur
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
| | - Bethany Glick
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
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Transition from paediatric to adult ophthalmology services: what matters most to young people with visual impairment. Eye (Lond) 2017; 32:406-414. [PMID: 28937148 DOI: 10.1038/eye.2017.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo identify the views and experiences and thus the transition-related needs of young people with visual impairment (VI), so as to inform future practice and policies.Patients and methodsQualitative study of 17 young people aged 16-19 years (ie the conventional transition age threshold) with VI (best-corrected acuity logMAR worse than 0.48) and without additional impairments, drawn from a sampling frame of paediatric ophthalmology patients attending Great Ormond Street Hospital and Moorfields Eye Hospital (London, UK). In-depth, semistructured interviews were conducted to elicit their experiences, preferences, and attitudes towards transitioning within health care. Qualitative thematic analysis identified themes related to participants' experience of transition.ResultsEight of 17 participants had transitioned out of paediatric ophthalmology services, 7 had not, and 2 were unsure. Their views and experiences varied. Only 2 of those who had transitioned preferred their prior paediatric service, and 1 still in a paediatric services did not want to transition. Age-appropriate communication and physical clinical environment were two key components of care, both associated with greater confidence to self-manage health care in the future as an adult. Emotional attachment to paediatric services/teams was associated with reluctance to transition.ConclusionsGeneric guidance on transition is broadly applicable to children/young people with VI. Age-appropriate communication and appropriate physical clinical environments may be optimally delivered through adolescent ophthalmology services bridging paediatric and adult provision. Lack of research on transitions in paediatric ophthalmology has thus far restricted intervention studies; our findings serve to aid in developing an evidence base to achieve this.
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Corathers SD, Kichler JC, Fino NF, Lang W, Lawrence JM, Raymond JK, Yi-Frazier JP, Dabelea D, Liese AD, Saydah SH, Seid M, Dolan LM. High health satisfaction among emerging adults with diabetes: Factors predicting resilience. Health Psychol 2017; 36:206-214. [PMID: 27736152 PMCID: PMC6296746 DOI: 10.1037/hea0000419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study was conducted to identify factors contributing to health satisfaction outcomes among emerging adults (ages 18-25) with diabetes. METHOD SEARCH for Diabetes in Youth study participants whose diabetes was prevalent in 2001 and were ≥18 years of age when they completed a 2008-2009 follow-up survey (n = 340) were included. We developed a health resilience model (HRM) to identify potentially modifiable factors (anticipatory guidance, social support, physical activity, quality of life) associated with health outcomes (satisfaction with health care, overall personal health, self-report of hemoglobin A1c [HbA1c]). Proportional odds logistic regression models were used to examine relationships between modifiable factors and health outcomes while adjusting for predetermined characteristics; linear regression models were used for reported HbA1c. Comparison of participants who reported HbA1c versus nonreporters was conducted. RESULTS A majority (70%) of participants rated satisfaction with health care ≥7 out of 10, and most (71%) rated overall health as good, very good, or excellent. Satisfaction with health care was independent of change in provider between the ages of 17 and 24. After controlling for predetermined characteristics, we found that the odds of increased satisfaction with health care and overall personal health were 1.3 and 1.2 greater, respectively, when participants discussed additional diabetes-related anticipatory guidance topics with a provider and 1.3 and 2.1, respectively, for each 10-unit change in quality of life score. Relationship between HbA1c level and modifiable factors was not significant; however, participants reporting HbA1c had higher ratings of health care and overall health versus nonreporters. CONCLUSIONS HRM describes relationships between modifiable factors and patient-reported outcomes of satisfaction with health care and overall personal health among a cohort of ethnically and racially diverse emerging adults with longstanding diabetes, over half of whom experienced a change in provider. HRM may discern candidate areas for intervention, such as effective anticipatory guidance that can impact satisfaction with health care and overall health, to promote positive health outcomes. (PsycINFO Database Record
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Affiliation(s)
| | - Jessica C Kichler
- Division of Behavioral Medicine and Clinical Psychology, Children's Hospital Medical Center
| | - Nora F Fino
- Department of Bio-statistical Sciences, Wake Forest School of Medicine
| | - Wei Lang
- Department of Bio-statistical Sciences, Wake Forest School of Medicine
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California
| | | | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health
| | | | - Sharon H Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention
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Tanenbaum ML, Hanes SJ, Miller KM, Naranjo D, Bensen R, Hood KK. Diabetes Device Use in Adults With Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets. Diabetes Care 2017; 40:181-187. [PMID: 27899489 PMCID: PMC5864141 DOI: 10.2337/dc16-1536] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/04/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes devices (insulin pumps, continuous glucose monitors [CGMs]) are associated with benefits for glycemic control, yet uptake of these devices continues to be low. Some barriers to device uptake may be modifiable through psychosocial intervention, but little is known about which barriers and which patients to target. RESEARCH DESIGN AND METHODS We surveyed 1,503 adult T1D Exchange participants (mean age 35.3 [SD 14.8] years, mean diagnosis duration 20.4 [SD 12.5] years) to investigate barriers to device uptake, understand profiles of device users versus nonusers, and explore differences by age and sex. Scales used were the Diabetes Distress Scale, Technology Use Attitudes (General and Diabetes-Specific), and Barriers to Device Use and Reasons for Discontinuing Devices. RESULTS Most commonly endorsed modifiable barriers were related to the hassle of wearing devices (47%) and disliking devices on one's body (35%). CGM users (37%) were older than nonusers (mean 38.3 vs. 33.5 years), had diabetes for longer (22.9 vs. 18.8 years), had more positive technology attitudes (22.6-26.0 vs. 21.4-24.8), and reported fewer barriers to using diabetes technology than nonusers (3.3 vs. 4.3). The youngest age-group (18-25 years) had the lowest CGM (26% vs. 40-48%) and insulin pump (64% vs. 69-77%) uptake, highest diabetes distress (2.2 vs. 1.8-2.1), and highest HbA1c levels (8.3% [67 mmol/mol] vs. 7.2-7.4% [55-57 mmol/mol]). CONCLUSIONS Efforts to increase device use need to target physical barriers to wearing devices. Because young adults had the lowest device uptake rates, highest distress, and highest HbA1c compared with older age-groups, they should be the focus of future interventions to increase device use.
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Affiliation(s)
- Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | | | - Diana Naranjo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Rachel Bensen
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Majumder E, Cogen FR, Monaghan M. Self-Management Strategies in Emerging Adults With Type 1 Diabetes. J Pediatr Health Care 2017; 31:29-36. [PMID: 26861574 PMCID: PMC4976043 DOI: 10.1016/j.pedhc.2016.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We examined changes in self-management behaviors after high school graduation in a cohort of emerging adults with type 1 diabetes. METHODS Sixty-four emerging adults reported on diabetes self-management behaviors at three time points over a 1-year period. Glycemic control and blood glucose monitoring frequency data were collected from the medical chart. RESULTS Collaboration with parents decreased, diabetes problem-solving and communication increased, and glycemic control worsened during the first year after high school (p < .05). Problem solving appeared to be protective against worsening glycemic control; higher baseline diabetes problem solving significantly predicted better glycemic control at the 1-year follow-up. DISCUSSION Emerging adults demonstrate increased independence in diabetes problem solving and communication with health care providers in the year after high school. Problem-solving skills may help emerging adults adapt type 1 diabetes self-care in response to unpredictable schedules after high-school, and promoting these skills may prevent deteriorations in glycemic control during this risky period.
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Factors influencing transitional care from adolescents to young adults with cancer in Taiwan: A population-based study. BMC Pediatr 2016; 16:122. [PMID: 27484184 PMCID: PMC4971729 DOI: 10.1186/s12887-016-0657-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 07/26/2016] [Indexed: 11/21/2022] Open
Abstract
Background To investigate the progress of transition from paediatric to adult health care for patients with cancer in Taiwan’s medical system. Methods The data were retrieved from the Longitudinal Health Insurance Database (LHID), which contains the original inpatient and outpatient medical claims data for 1,000,000 enrollees randomly sampled from the NHIRD between 1997 and 2010. Results Among the 1,411 cancer patients selected for this study, 98.09 % received adult-oriented therapy before the age of 18. In addition, only 1.91 % of the patients received paediatric-oriented therapy during adolescence. The primary factors that determine whether these patients would receive paediatric-oriented therapy or adult-oriented therapy at an early age were as follows: the age of the patient at the first visit and the performance-level of the hospital (p < 0.001). Conclusions Previous studies conducted in developed countries have demonstrated that the unwillingness of patients to switch from paediatric-oriented therapy to adult-oriented therapy being the major obstacle that hinders the transition process. However, this study revealed a different result: the implementation of the National Health Insurance system in Taiwan makes healthcare affordable for the adolescent patients who may not possess adequate knowledge about paediatric health care and may not appreciate paediatric-oriented therapy, thereby hindering the transition process.
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Los E, Ulrich J, Guttmann-Bauman I. Technology Use in Transition-Age Patients With Type 1 Diabetes: Reality and Promises. J Diabetes Sci Technol 2016; 10:662-8. [PMID: 26892506 PMCID: PMC5038542 DOI: 10.1177/1932296816632543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with chronic illnesses have the greatest risk for a decline in their health management during transition-age. Because of this demonstrated and well-known issue, research has focused on how to improve the transition of care process. Despite the increasing number of technological devices on the market and the advances in telemedicine modalities available to patients with type 1 diabetes (T1D), the utilization of technology is still suboptimal among patients of transition-age (ages 13-25). This article reviews the available resources, patterns of use in transition-age youth, and explores opportunities to advance technology use in transitioning patients with T1D from pediatric to adult care.
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Affiliation(s)
- Evan Los
- Oregon Health & Science University, Portland, OR, USA
| | - Jenae Ulrich
- Oregon Health & Science University, Portland, OR, USA
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47
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Sobota AE, Umeh E, Mack JW. Young Adult Perspectives on a Successful Transition from Pediatric to Adult Care in Sickle Cell Disease. ACTA ACUST UNITED AC 2016; 2:17-24. [PMID: 27175364 PMCID: PMC4862600 DOI: 10.12974/2312-5411.2015.02.01.3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective This qualitative study sought to learn from young adults with sickle cell disease (SCD) about their experience leaving pediatric care and perspective on what makes a successful transition. Methods Fifteen young adults with SCD who had left pediatric care within the previous five years participated in focus groups led by a trained moderator. Transcripts were analyzed using grounded theory. Results Four main themes emerged from the analysis: facilitators of transition (meeting the adult provider prior to transfer, knowing what to expect, gradually taking over disease self-management and starting the process early), barriers to transition (negative perceived attitude of adult staff, lack of SCD specific knowledge by both patients and staff, and competing priorities interfering with transition preparation), what young adults wished for in a transition program (opportunities to meet more staff prior to transfer, more information about the differences between pediatric and adult care, learning from a peer who has been through the process, more SCD teaching, and flexibility in transition preparation) and how they define a successful transition (gradually assuming responsibility for self-management of their SCD). Conclusion Our findings present unique opportunities to learn from young adults with SCD about ways to improve current transition programs.
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Affiliation(s)
- Amy E Sobota
- Boston University School of Medicine, Boston, MA; Boston Medical Center, Department of Pediatrics, Boston, MA
| | - Emeka Umeh
- Boston University School of Public Health, Boston, MA
| | - Jennifer W Mack
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Harvard Medical School, Boston, MA
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Steinbeck KS, Shrewsbury VA, Harvey V, Mikler K, Donaghue KC, Craig ME, Woodhead HJ. A pilot randomized controlled trial of a post-discharge program to support emerging adults with type 1 diabetes mellitus transition from pediatric to adult care. Pediatr Diabetes 2015; 16:634-9. [PMID: 25385685 DOI: 10.1111/pedi.12229] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/30/2022] Open
Abstract
AIMS There is a paucity of randomized controlled trials (RCT) examining transition from pediatric to adult care in type 1 diabetes mellitus (T1DM). This study aimed to determine if transition in T1DM is more effective with a comprehensive transition program (CTP) compared with standard clinical practice (SCP). METHODS This RCT recruited as young people left pediatric diabetes services. The trial co-ordinator provided CTP participants with standardized telephone communication support at week 1, and 3, 6, and 12 months post-discharge from pediatric care. SCP participants were briefly contacted at 6 and 12 months post-discharge to confirm transfer status; they received no other post-discharge contact as per usual practice. At 12 months, the primary outcomes were engagement and retention in the adult service and secondary outcomes included hemoglobin A1c (HbA1c), diabetes-related hospitalizations, microvascular complication appearance, and global self-worth. RESULTS Most CTP participants (11/14) and all SCP (12/12) participants (P = 0.2) transferred to an adult diabetes service; the median time to transfer was 14-15 wk. Overall, participants' frequency of adult diabetes service visits was sub-optimal but their retention in adult care was high. The only group difference was a higher HbA1c at baseline and follow-up in the CTP group. However, a general linear model found that follow-up HbA1c increased by 1.2% for each percentage increase in baseline HbA1c [95% confidence interval (0.4, 1.9; P = 0.01)], independent of treatment group. CONCLUSIONS Despite the challenges in recruiting adequate numbers, these findings provide valuable insights for future T1DM transition RCTs that are needed to build a more solid evidence-base in this field.
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Affiliation(s)
- Katharine S Steinbeck
- Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Vanessa A Shrewsbury
- Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Vanessa Harvey
- Department of Adolescent and Transitional Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kara Mikler
- Department of Paediatric Endocrinology, The Sydney Children's Hospital at Randwick, Randwick, NSW, Australia
| | - Kim C Donaghue
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Sydney Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Maria E Craig
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Sydney Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Helen J Woodhead
- Department of Paediatric Endocrinology, The Sydney Children's Hospital at Randwick, Randwick, NSW, Australia
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Polfuss M, Babler E, Bush LL, Sawin K. Family Perspectives of Components of a Diabetes Transition Program. J Pediatr Nurs 2015; 30:748-56. [PMID: 26088279 DOI: 10.1016/j.pedn.2015.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/13/2015] [Accepted: 05/17/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the perspectives of adolescent/parent dyads about a diabetes program on: (1) perception of knowledge, self-efficacy, importance of transition behaviors and ability to self-manage diabetes, (2) the congruency of knowledge and skills important for transition, (3) program specifics families determined helpful for transition, and (4) the relationship of adolescents' self-efficacy to self-management behaviors (SMB) and Hemoglobin A1C (HbA1C). METHODS The individual and family self-management theory guided this prospective cross-sectional study. Sample included 45 dyads from a pediatric diabetes program. Dyads independently completed questionnaires related to knowledge, self-efficacy, the importance of specific diabetes knowledge and skills, and behaviors helpful for self-management and transition readiness. Analysis included frequencies, correlations, Cronbach's alpha, and paired t-tests. RESULTS Knowledge was high and self-efficacy even higher in the dyads. However, they did not agree on behaviors important for transition such as, knowing what the HbA1C should be, accurately counting carbohydrates, how to check ketones, how alcohol and drugs affect diabetes, or consistent documentation of blood sugar, carbohydrates and insulin doses. Adolescents indicated talking with providers and program materials as helpful, but attending regular visits and talking with parents as most helpful for transition. Adolescent and parent assessment of adolescent self-efficacy and self-management behaviors were strongly correlated. Family dyad's perceptions of adolescent self-efficacy were similar but not related to HbA1C. CONCLUSION A diabetes transition program has the opportunity to impact an adolescent's ability to self-manage their chronic illness by increasing self-efficacy and recognizing the strengths of the parent, adolescent and provider in the transition process.
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Affiliation(s)
- Michele Polfuss
- University of Wisconsin- Milwaukee College of Nursing -Milwaukee, WI/Children's Hospital of Wisconsin, Milwaukee, WI.
| | - Elizabeth Babler
- University of Wisconsin- Milwaukee College of Nursing, Milwaukee, WI
| | - Loretta L Bush
- Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI
| | - Kathleen Sawin
- University of Wisconsin- Milwaukee College of Nursing/Children's Hospital of Wisconsin, Milwaukee, WI
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Sheehan AM, While AE, Coyne I. The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: a systematic review. Diabet Med 2015; 32:440-58. [PMID: 25407592 DOI: 10.1111/dme.12639] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Despite the transition between child and adult services for young people with Type 1 diabetes mellitus being a high-risk period, little is known about the impact of healthcare transition upon young people. METHODS A systematic review was conducted using PubMed, PsycINFO, CINAHL and EMBASE. Papers published between January 2001 and June 2014 that examined the impact or experiences of healthcare transition in young people with Type 1 diabetes were included. Data were extracted by two independent reviewers and integrated by narrative synthesis. RESULTS A total of 8990 citations were reviewed and 43 studies were included in the review, 24 of which explored the impact of transition and 24 examined experiences of transition. There were mixed results in terms of the change in glycaemic control and diabetes-related hospitalizations, but all studies assessing attendance found worse attendance post-transition. Data regarding experiences reported that young people and parents experienced greater difficulty in accessing and maintaining diabetes health care. Young people were required to develop independent self-management and self-advocacy skills to navigate the transition and adult health care, but some were inadequately prepared for this. CONCLUSIONS Although the impact of healthcare transition on outcomes for young people with Type 1 diabetes is unclear due to the paucity of high-quality studies, transition appears to be associated with decreased clinic attendance. There is some preliminary evidence of a positive impact of structured transition programmes. Experiences of healthcare transition illuminate the barriers to smooth transitions and the need for better integration and continuity of care.
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Affiliation(s)
- A M Sheehan
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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