Diabetes Educator, Nutritionist Facilitate Successful Transition From Pediatric to Adult Care for Type 1 Diabetes

The following article is part of the coverage of the American Association of Clinical Endocrinology Annual Meeting 2021 conference: ENVISION, which will be held virtually from May 26 to May 29, 2021. The Endocrinology Advisor team will report on the latest news and research conducted by leading experts in the field. Check back for more information on the 2021 AACE Annual Meeting: ENVISION.

Adolescents and young adults with type 1 diabetes who had a visit to a certified diabetes educator or nutritionist, or who used a continuous glucose monitor, were found to have a smaller gap in health care in transitioning from pediatric to adult care, according to study results presented. at the 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021).

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Duke University Health System researchers retrospectively examined the medical records of 299 adolescents and young adults for clinical features and health care use during their transition from pediatric to adult care. Patients who required a minimum of 3 years to have an adult care consultation were excluded.

More than half of the participants (54.8%) were female, 73.4% were Caucasian, the median number of annual endocrine consultations in children was 2.5 (interquartile range [IQR], 2.1-3) and mean glycated hemoglobin (HbA1c) at the last pediatric visit was 9.4% ± 2.14%. The median transition time from pediatric to adult comfort was 14.09 (IQR, 4.58-43.80) months.

The gap in care was significantly longer in patients who did not see a nutritionist, increasing 2.03-fold (95% CI: 1.53-3.46; P < 0.01); the gap in care increased by a factor of 1.83 (95% CI, 1.10-3.05; p = 0.02) in patients who had not seen a certified diabetes educator and by a factor of 1.67 ( 95% CI, 1.03-2.71; p = .04) in patients not using a continuous glucose meter.

Gap in care during transition was not associated with HbA1c value (P = .11), insulin pump use (P = .21), number of hospitalizations (P = .48), number of ED visits (P = .28), anxiety (P = .037), or depression (P = .82).

This study may not be generalizable because patients with long transition times were excluded from participation.

These data indicate that consultation with a nutritionist or diabetes educator and use of a continuous glucose monitor are associated with shorter care gaps during the transition from pediatric to adult health care in patients with type 1 diabetes.

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Soliman D, Crowley MJ, Manning A, Rikhi A, Chiswell K, Maslow G. Transition from pediatric to adult care in type 1 diabetes mellitus: a longitudinal analysis of clinical features. Presented at: AACE Virtual Annual Meeting 2021, May 26-29, 2021.

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