148-LB: Demographic Factors Predict Successful Transition to Adult Care in Adolescents and Emerging Adults with Type 1 Diabetes

Background: Adolescents and emerging adults with T1D are a particularly vulnerable group among those with this chronic disease. Previous work has shown that this group has the highest HgbA1c of any age cohort with the disease. While it has been shown that maintaining engagement with care can help improve disease control, there is limited evidence to identify those at most risk of being lost to follow up at this care transition. The current study used visit-level EHR data to analyze demographic and visit data to determine predictors of successful pediatric to adult transition.

Methods: This is a retrospective cohort study of 4,185 patients with T1D who were seen in the pediatric diabetes clinic at least once in three consecutive calendar years between 2004 and 2020. The primary outcome of interest was completion of at least 1 adult endocrinology clinic visit for T1D care. Patients were compared using descriptive statistics and logistic regression to analyze demographic factors and key disease metrics including HgbA1c and hospital admission.

Results: Among study subjects, 730 completed transition to adult care within our health system. Those completing transition has about one fifth the odds (aOR 0.22 95%CI: 0.15 - 0.32) of having private insurance compared to patients who did not transition. No other significant demographic differences were found between the two groups. Among those who did transition, the median time from last pediatric to the first adult visit was 190 days (IQR 100 - 542) with only 53.2% completing their first adult visit within 6 months.

Discussion: Our data suggest that insurance is the most significant barrier to transition from our pediatric to adult clinics for patients with T1D. Importantly, even among those who do ultimately receive care from our adult clinics, we identified significant gaps in care. Improving our processes for transitions should focus on closing these gaps to help emerging adults maintain engagement in their T1D care.