Abstract
Adolescents with type 1 diabetes struggle with glycemic control with decline further
exacerbated by transfer from pediatric to adult care. The purpose of this systematic
review/meta-analysis was to examine which components of transition programs are effective
in improving outcomes following transfer. We searched six databases for studies that
assessed the efficacy of a transition program on diabetes outcomes. Studies reporting
hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition
and posttransition were pooled using a random effects meta-analysis model. Of 4,689
studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective,
and 10 retrospective cohort) met inclusion criteria. Findings represent data from
3,382 youth with type 1 diabetes (52% male, age 16–23 years) undergoing transition.
Programs varied and included transition coordinators (n = 7), transition clinics (n =
10), and group education meetings (n = 5). Average age of transfer was 17.7 years.
All but one study reported improvement/maintenance of HbA1c posttransition. However,
pooling data from four studies with a control group (418 youth), there were no differences
in HbA1c at 12 months (−.11 [95% confidence interval: −.31, .08]). Of other outcomes
studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis
[n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis
episodes. Findings suggest that transition interventions may be effective in maintaining
glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further
research is needed to determine which program types are most effective.
Keywords
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References
- Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002-2009.Diabetes. 2014; 63: 3938-3945
- Diabetes in the young—a global view and worldwide estimates of numbers of children with type 1 diabetes.Diabetes Res Clin Pract. 2014; 103: 161-175
- Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: Dynamic modeling of incidence, mortality, and population growth.Diabetes Care. 2012; 35: 2515-2520
- Youth with special health care needs: Transition to adult health care services.Matern Child Health J. 2013; 17: 1744-1752
- Hemoglobin A1c (HbA1c) changes over time among adolescent and young adult participants in the T1D exchange clinic registry.Pediatr Diabetes. 2016; 17: 327-336
- Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence.Pediatrics. 2013; 131: e1062-e1070
- Diabetes in the adolescent: Transitional issues.J Clin Endocrinol Metab. 2013; 98: 4639-4645
- Health care transition in young adults with type 1 diabetes: Barriers to timely establishment of adult diabetes care.Endocr Pract. 2013; 19: 946-952
- Health care transition in young adults with type 1 diabetes: Perspectives of adult endocrinologists in the United States.Diabetes Care. 2016; 39: 190-197
- Supporting the health care transition from adolescence to adulthood in the medical home.Pediatrics. 2011; 128: 182-200
- ISPAD Clinical practice consensus guidelines 2014. Diabetes in adolescence.Pediatr Diabetes. 2014; 15: 245-256
- Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems: A position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, the Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society).Diabetes Care. 2011; 34: 2477-2485
- Transition to adult health care for adolescents and young adults with chronic conditions: Position paper of the Society for Adolescent Medicine.J Adolesc Health. 2003; 33: 309-311
- Factors determining diabetes care outcomes in patients with type 1 diabetes after transition from pediatric to adult health care: A systematic review.JBI Database Syst Rev Implementation Rep. 2014; 12: 374-412
- The experiences and impact of transition from child to adult healthcare services for young people with type 1 diabetes: A systematic review.Diabet Med. 2015; 32: 440-458
- Barriers and facilitators associated with attendance at hospital diabetes clinics among young adults (15-30 years) with type 1 diabetes mellitus: A systematic review.Pediatr Diabetes. 2016; 17: 509-518
- A systematic review of interventions aimed at the transition from pediatric to adult care for youth with type 1 diabetes.PROSPERO: Int prospective Regist Syst Rev. 2015; (Available at:) (Accessed July 6, 2015)
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.J Epidemiol Community Health. 1998; 52: 377-384
- 'The Lost Tribe': A study of transition care in Lothian.Br J Diabetes Vasc Dis. 2015; 15: 70-74
- IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: A method-comparison study.Clin Chem. 2004; 50: 166-174
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13
- Family responsibility dynamics for young adults in transition to adult health care.J Diabetes Mellitus. 2013; 3: 139-144
- A pilot randomized controlled trial of a post-discharge program to support emerging adults with type 1 diabetes mellitus transition from pediatric to adult care.Pediatr Diabetes. 2015; 16: 634-639
- Transition and beyond in adolescents and young adults with type 1 diabetes mellitus.Int J Endocrinol Metab Disord. 2015; 1
- Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: Update of the evidence for the U.S. Preventive Dervices Task Force.Agency for Healthcare Research and Quality, Rockville, MD2010
- Telemedicine aids diabetes care.Independent Nurse. June 2009; (p.10)
- The Maestro Project: A patient navigator for the transition of care for youth with type 1 diabetes.Diabetes Spectr. 2011; 24: 9-13
- Evaluation of a systems navigator model for transition from pediatric to adult care for young adults with type 1 diabetes.Diabetes Care. 2008; 31: 1529-1530
- Midterm impact of a specially designed therapeutic education programme in patients transferred from a paediatric to an adult diabetes unit.Diabetologia. 2013; 56 ([Abstract]): S453
- The effect of a structured transition process from pediatric department to an adolescence clinic on HbA1c and adherence in young type 1 diabetes patients.Diabetes. 2012; 61 ([Abstract]): A633
- A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with type 1 diabetes aged 15-25 years.Diabet Med. 2007; 24: 764-769
- Let's empower and prepare (LEAP): Evaluation of a structured transition program for young adults with type 1 diabetes.Diabetes Care. 2015; 38: 1412-1419
- Impact of a special therapeutic education programme in patients transferred from a paediatric to an adult diabetes unit.Eur Diabetes Nurs. 2004; 1: 23-27
- Glycemic control and transfer of health care among adolescents with insulin dependent diabetes mellitus.J Adolesc Health. 1996; 18: 44-47
- Transition process of patients with type 1 diabetes (T1DM) from paediatric to the adult health care service: A hospital-based approach.Clin Endocrinol (Oxf). 2009; 71: 346-350
- Audit of young people with type 1 diabetes transferring from paediatric to adult diabetic services.Pract Diabetes Int. 2006; 23: 106-108
- Current methods of transfer of young people with type 1 diabetes to adult services.Diabet Med. 2002; 19: 649-654
- Glycemic control over 3 years in a young adult clinic for patients with type 1 diabetes.Diabetes Res Clin Pract. 2007; 78: 385-391
- Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic.Acta Diabetol. 2016; 53: 27-33
- Smoothing the transition from paediatric to adult services in type 1 diabetes.J Diabetes Nurs. 2008; 12: 328-338
- Transition to adult care for youths with diabetes mellitus: Findings from a Universal Health Care System.Pediatrics. 2009; 124: e1134-e1141
- 11. Children and adolescents.Diabetes Care. 2016; 39: S86-S93
- Current state of type 1 diabetes treatment in the U.S.: Updated data from the T1D Exchange clinic registry.Diabetes Care. 2015; 38: 971-978
- Associations of demographic and behavioural factors with glycaemic control in young adults with type 1 diabetes mellitus.Intern Med J. 2016; 46: 332-338
Children with Diabetes. Children with diabetes. Available at: http://www.childrenwithdiabetes.com Accessed September 9, 2016.
T1D Exchange. Glu. Available at: https://myglu.org. Accessed September 9, 2016.
- Teens, health and technology: A national survey.Media Commun. 2016; 4
- Text message interventions for children and adolescents with type 1 diabetes: A systematic review.Diabetes Technol Ther. 2013; 15: 362-370
- Preparing adolescents with chronic disease for transition to adult care: A technology program.Pediatrics. 2014; 133: e1639-e1646
- Prevalence of depression among young people with type 1 diabetes: A systematic review.Diabet Med. 2013; 30: 199-208
- Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with type 1 diabetes.Diabet Med. 2014; 31: 1615-1624
- Transition to adult care for youth with special health care needs.Paediatr Child Health. 2007; 12: 785-793
- Health outcomes associated with transition from pediatric to adult cystic fibrosis care.Pediatrics. 2013; 132: 847-853
- Transition of care for adolescents from paediatric services to adult health services.Cochrane Database Syst Rev. 2016; : CD009794
Article info
Publication history
Published online: December 06, 2016
Accepted:
October 6,
2016
Received:
June 30,
2016
Footnotes
Conflicts of interest: The authors have no conflicts of interest to disclose.
Disclaimer: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2016 Society for Adolescent Health and Medicine. All rights reserved.
