Background: The transition from pediatric to adult care is a high risk time for young adults with diabetes associated with poor glycemic control and psychosocial challenges. However, little is known about how to prospectively identify patients most at risk during transition. Thus, we screened young adults for diabetes distress as part of a multidisciplinary diabetes transition program and identified correlations between distress and patient outcomes.
Methods: Diabetes distress was measured during enrollment in the Michigan Medicine Diabetes Transition Program (MMDTP) using the Problem Areas in Diabetes (PAID) questionnaire, a validated diabetes distress screening tool. Patients with high distress were referred to the program social worker. We performed a retrospective chart review on MMDTP participants who were screened from 7/2017 to 12/2018.
Results: Fifty-eight young adults (age 17-23 years) completed distress screening, with PAID scores ranging from 0 to 82.5 (median 11.9). 13.8% of patients had high distress (PAID>40). Mean HbA1c prior to transition was 9.7 ± 2.3% and did not correlate with PAID scores nor did distress correlate with insulin pump or continuous glucose monitor use. Among 48 patients >1 year from first adult endocrine visit, those attending at least 3 visits in the first year (n=35) had lower median PAID scores than those attending 2 or fewer visits (10.0 vs. 26.2, p=0.02). Those attending at least 3 visits also had significantly lower mean HbA1c prior to transition (9.0% vs. 12.2%, p<0.01).
Discussion: Here we report the successful implementation of diabetes distress screening for young adults during the transition to adult care. While distress scores were lower than anticipated based on prior studies, we still found 13.8% of our patients had high distress levels. High distress and HbA1c levels at program entry both correlated with reduced visit frequency in the first year post-transition. Future interventions will aim to improve clinic attendance in patients with high distress.
K. Rodeman: None. A. Rao: None. A. Konigsberg: None. L. Ang: None. I.H. Thomas: None. S. Soleimanpour: None. J.J. Iyengar: None.