Transition between pediatric and adult diabetes care is often associated with new responsibilities in diabetes care and increased risk of acute complications. This study examines post-transition rates of acute complications and independence in diabetes self-care as a function of student and employment status based on time since transfer.
The study included young adults with type 1 diabetes (T1D) between 18-26 years of age who completed a SEARCH for Diabetes in Youth Study visit between 2016-2019. Subgroup analysis compared those that transitioned care to an adult provider in the past 2 years to those who had transitioned ≥2 years prior. Chi-squared tests and linear and logistic regression models were applied. The models for diabetes complications and care included an interaction term between student and employment status and adjusted for gender, race/ethnicity, age, education level, insurance type, diabetes duration, and site.
1,043 participants were included in the analysis (56.6% female, mean age 22.2±2.5 years, mean T1D duration 11.7±3.0 years). Overall, 65.9% of participants had transferred to an adult diabetes care provider prior to their study visit. Among those who transitioned within the past two years (N=254), unemployed non-students were significantly more likely to experience diabetic ketoacidosis or severe hypoglycemia than unemployed students (p=0.01). Non-students who transferred within the past two years were less likely to be performing all diabetes self-care independently (p=0.03).
In conclusion, recent transition from pediatric to adult diabetes care represents a high-risk period for acute complications, specifically for non-students who are unemployed. For those who had transitioned in the past 2 years, students were more likely to be independent in their diabetes self-care. Additional support may be needed in this group to improve independent diabetes care and reduce the risk for acute complications.
S. Majidi: Advisory Panel; Self; Companion Medical. R. Wadwa: Consultant; Self; Tandem Diabetes Care, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care. C. Pihoker: None. A. J. Roberts: None. C. Suerken: None. B. A. Reboussin: None. F. Malik: None. S. M. Marcovina: None. S. Corathers: None. K. Reynolds: Research Support; Self; Merck & Co., Inc. G. Imperatore: None.
National Institutes of Health (1UC4DK108173, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); Centers for Disease Control and Prevention