Elizabeth A Pyatak1, Paola A Sequeira2, Cheryl L P Vigen3, Marc J Weigensberg2, Jamie R Wood4, Lucy Montoya5, Valerie Ruelas5, Anne L Peters5. 1. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California. Electronic address: beth.pyatak@chan.usc.edu. 2. Department of Pediatrics, University of Southern California, Los Angeles, California. 3. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California. 4. Department of Pediatrics, University of Southern California, Los Angeles, California; Children's Hospital of Los Angeles, Los Angeles, California. 5. Keck School of Medicine, University of Southern California, Los Angeles, California.
Abstract
PURPOSE: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. METHODS: Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program. RESULTS: At baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04). CONCLUSIONS: Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.
PURPOSE: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. METHODS: Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program. RESULTS: At baseline, LCparticipants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LCparticipants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LCparticipants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04). CONCLUSIONS: Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.
Authors: Katharine C Garvey; Howard A Wolpert; Lori M Laffel; Erinn T Rhodes; Joseph I Wolfsdorf; Jonathan A Finkelstein Journal: Endocr Pract Date: 2013 Nov-Dec Impact factor: 3.443
Authors: Kellee M Miller; Nicole C Foster; Roy W Beck; Richard M Bergenstal; Stephanie N DuBose; Linda A DiMeglio; David M Maahs; William V Tamborlane Journal: Diabetes Care Date: 2015-06 Impact factor: 19.112
Authors: Paola A Sequeira; Elizabeth A Pyatak; Marc J Weigensberg; Cheryl P Vigen; Jamie R Wood; Valerie Ruelas; Lucy Montoya; Marisa Cohen; Heather Speer; Susan Clark; Anne L Peters Journal: Diabetes Care Date: 2015-04-23 Impact factor: 19.112
Authors: Joyce P Yi-Frazier; Kirsten Senturia; Davene R Wright; Cara Lind; Faisal S Malik Journal: J Pediatr Nurs Date: 2021-07-20 Impact factor: 2.523
Authors: Anna Vágvölgyi; Ágnes Maróti; Mónika Szűcs; Csongor Póczik; Dóra Urbán-Pap; István Baczkó; Attila Nemes; Éva Csajbók; Krisztián Sepp; Péter Kempler; Andrea Orosz; Tamás Várkonyi; Csaba Lengyel Journal: Front Endocrinol (Lausanne) Date: 2021-08-27 Impact factor: 5.555