Identifying Barriers of Our Youngsters with Type 1 Diabetes Transitioning to an Adult Unit

Youngsters with type 1 diabetes feel anxious when transitioning from Pediatric to Adult Care. Loss of attendance and worsening of metabolic control are related to it. Some barriers reported are difficulty in getting appointment, unknown referral health-care provider and work issues.

Objective: To evaluate loss of attendance, metabolic control and satisfaction in a cohort of youngsters with T1D transitioning to Adult Care.

Methods: All Kids with T1D transitioning between 2015-2017 were included. Clinical/demographic data were collected. A1c levels prior and 1 year after Transition were compared. Loss of attendance was defined as “loss of 2 following visits.” An anonymous survey was created ad hoc to evaluate satisfaction. It had 15 questions with a 1-5 scale, being 1 “never” and 5 “always.”

Results: 42 kids transitioned. 31% women, transition age 18(±1.8) years, diabetes duration 11(±4.4) years, 16.7%CSII, 83.9% were students. Delay between Pediatrics and Adults was 2.84(±1.9) months. A1c before and after 1 year were similar: 7.8(±1.5)% vs. 7.9(±1.5)%,p=ns). Loss of attendance occurred in the 2^nd year in 3 patients (7.1%). Only worsening of A1c the year before was associated with it. 80.9% of patients answered the survey. Satisfaction degree was “most of the times” or “always” in >80% in questions related to: moment of transition, welcome, time expend on each visit, confidentiality, referral contact name/phone, share decision making or understanding therapy instructions. However, 1 out of 3 patients disagreed in questions about emotional support, feeling comfortable to talk about sex/drugs or feeling free to express their thoughts. Work issues was the most common cause of not compliance to visits.

Conclusion: Although rate of loss of visits is low and maintenance of metabolic control has been observed through Transition, an effort has to be made in our Team to improve satisfaction in terms of freedom to talk about sex or drugs, freedom to express their thoughts and to support their emotional needs.