Rapid Improvement of Metabolic Control in Type 1 Diabetes after Transition from Paediatric Clinics to an Adult Diabetes Center

Transition from paediatric to adult diabetes clinics for type 1 diabetes (T1D) patients represents a critical phase often characterized by worsening effects on diabetes outcomes as care visit attendance, metabolic control and diabetes related complications. Aim of this study was to evaluate metabolic control of 122 T1D patients [82/40 M / F, mean (SD), age 25.1 ± 5.7 years, disease duration 17.2 ± 8.1 years, HbA1c 7.9% ± 1.4] at time of transition from paediatric clinics to our adult diabetes center. At baseline, 102 patients were on multiple daily insulin injections (MDI) and 20 subjects were on continuous subcutaneous insulin infusion (CSII). The transition process was performed in a specific "transition clinic" according to the protocol of the Consensus Statement of the American Academy of Paediatrics, American Diabetes Association, Academy of Family Physicians and the American College of Physicians. Results after 3 and 6 months follow-up showed a significant improvement in metabolic control with reduction of HbA1c in the whole population [Δ HbA1c 0-3 months: -0.3% (p <0.05), Δ HbA1c 0-6 months: -0.5% (p <0.02)] as well as in the different age groups [15-20, 21-30 (p <0.05, p <0.001, respectively)]. At baseline females showed a worst metabolic control compared to male patients (HbA1c: 8.3% ± 1.5 vs. 7.6% ± 1.1, p = 0.005) and this result was confirmed at the end of the study period (HbA1c: 7.9% ± 1.0 vs. 7.1% ± 0.8, p <0.001). After 6 months since transition 27% of patients were on CSII compared to 16% of patients in the pre-transfer period, however improvement of metabolic control was independent of CSII use.

In conclusion, our data showed that transition from paediatric to our adult diabetes center promotes a very fast reduction of HbA1c already detectable after 3 months of follow-up. This unexpected improvement is likely due not only to increased use of technology but to a more proper clinical setting for emerging adults as recommended by different scientific societies.