Background and Aim: Our previous data showed that transition from pediatric to an adult care center (ACC) improves glycaemic control in youth with type 1 diabetes (T1D). However, factors that might impact the success of transition are still unclear. In this study we aimed to evaluated whether metabolic control after transition differs by different ACC, insulin regimens and age at transition.
Methods: In this retrospective observational study we evaluated data from 178 patients with T1D moving from two pediatric clinics to two different ACC in Rome. The transition process was performed according to the American Diabetes Association Standard of Care. A1c was reassessed three and six months after transition and compared to baseline values by within-subjects analysis of variance, fitting interaction terms with referral center, baseline insulin regimen (multiple daily insulin injection [MDI] and continuous subcutaneous insulin infusion [CSII]) and age.
Results: At baseline, mean ± SD age was 28.4 ± 6.7 years, disease duration was 18.6 ± 8 years and A1c was 7.9 % ± 1.3. Mean transition gap was 8.0 ± 6.2 months. A1c values significantly improved both three (ΔA1c: -0.2%, p <0.001), and six months (ΔA1c: -0.4 %, p <0.001) after transitioning. At 6 months, ΔA1c was similar in the two centers (-0.4±1.0% and -0.4±0.7, p-value for interaction: 0.58) and in subjects on MDI or CSII at baseline (-0.5±1.0% and -0.4±0.6%, p-value for interaction: 0.37). No interaction between age at baseline and time was found (p-value: 0.22) The number of subjects on CSII increased from 46 (26.9%) at baseline to 64 (37.4%) after 6 months. There was no difference in A1c improvement between subjects changing compared to those not changing insulin regimen (p-value: 0.71).
Conclusion: This study shows a rapid improvement of metabolic control in T1D after transition, regardless of referral center, insulin regimen and age at transition. Further analysis evaluating different educational programs are needed.
S. Pieralice: None. E. Maddaloni: Consultant; Self; Merck KGaA. Speaker’s Bureau; Self; Abbott, AstraZeneca, Pikdare. C. Moretti: None. A. Maurizi: Employee; Self; AstraZeneca. C. Mignogna: Research Support; Self; Eli Lilly and Company. Other Relationship; Self; AstraZeneca. S. Dinatale: None. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. R. Buzzetti: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Lilly Diabetes, Merck Sharp & Dohme Corp.