When young adults with type 1 diabetes move from paediatric to adult care they often drop out of medical care and their diabetic control deteriorates. This can lead to increased diabetes-related hospital admissions and acceleration of diabetic complications. Lawson Health Research Institute scientists Drs. Tamara Spaic and Cheril Clarson have developed a structured transition program that has been shown to improve care during this high-risk period.
The new transition program was implemented as part of a multi-center randomized controlled trial, which began in 2012 and is concluding this year. Drs. Spaic and Clarson found that the program led to better clinic attendance among participants. During the time when patients received the intervention, they also reported being more satisfied with their care and felt that the emotional burden of their diabetes had decreased.
"The transition from paediatric to adult diabetes care coincides with the time in patients' lives when they are going away to college or university, starting their careers, and becoming independent from their parents. On top of these other changes, they are taking on responsibility for managing their own care, which requires a high level of patient involvement and can be a big adjustment in itself," explains Dr. Clarson who is also a pediatric endocrinologist at Children's Hospital, London Health Sciences Centre (LHSC) and a professor at Western University's Schulich School of Medicine & Dentistry.
The transition program was designed to provide additional support to young adults making the transition to adult care and included having a certified diabetes educator act as a dedicated Transition Coordinator. The coordinator attended the patients' clinic visits, and was accessible between visits by email, text or phone to problem solve specific diabetes care issues, and to guide patients as they adjusted to care at a new facility.
One of the patients in the study, Nicole, was diagnosed with type 1 diabetes at age 13. She was 19 when she participated in the structured transition intervention program, moving from paediatric care at Children's Hospital, LHSC to adult care at St. Joseph's Health Care London (St. Joseph’s). She found that the additional guidance helped her make a more gradual and, ultimately successful, transition.
"Having my Transition Coordinator attending my appointments with me made me feel more comfortable talking to my new healthcare team. Following appointments, as well as any other time during the transition, she answered all the questions I had," says Nicole. "Moving to adult care can be really overwhelming but I think if young patients have a positive experience during the transition they will be more likely to maintain proper diabetes care habits as they take on responsibility for their own care."
The study enrolled 205 young adults with type 1 diabetes between the ages of 17 and 20. Patients were recruited from three paediatric centers and their care was transitioned to three adult centres. The trial was a multi-centre partnership among Children's Hospital, LHSC; St. Joseph's; Children's Hospital of Eastern Ontario; The Ottawa Hospital and Trillium Health Partners in Mississauga.
The study participants were randomly assigned to two groups, with 104 patients in the structured transition care program and 101 patients receiving standard care. Patients were seen in the paediatric care setting for six months and then transferred to adult care, where they continued with either the transition program or standard care for one year.
"Our hope is that support from a Transition Coordinator will become a standard of care for young adults with type 1 diabetes during the transition from paediatric to adult care. A similar model could also be considered for other chronic childhood conditions, such as cystic fibrosis, congenital heart disease and inflammatory bowel disease," says Dr. Spaic, an adult endocrinologist at St. Joseph's and an assistant professor at Schulich Medicine & Dentistry.
Future publications from the trial will include a one-year follow-up evaluation after completion of the intervention, as well as an economic analysis to determine if the intervention is associated with health cost savings.
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Lawson Health Research Institute: As the research institute of London Health Sciences Centre and St. Joseph's Health Care London, and working in partnership with Western University, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world. http://www.lawsonresearch.ca