Transition from pediatric to adult care in patients with type 1 diabetes. The current situation in Argentina
DOI:
https://doi.org/10.47196/diab.v48i3.187Keywords:
type 1 diabetes, transition, health careAbstract
Objetive: to evaluate the impact of the transition process from pediatric to adult care in patients with type 1 diabetes, and to gather information for a diagnosis of the present health care situation regarding this matter in Argentina.
Material and methods: observational study where all the patients that had been followed-upat the Hospital Prof. Dr. Juan Pedro Garrahan and had been transferred to adult care from 2001 to 2006 were identified through hospital registries. Clinical
and biological information of metabolic controls corresponding to the last year of the pediatric follow-up, and the last year of the follow-up in the adult center were evaluated. Social and demographic data and information about adult health care were
assessed. Data were analyzed with the Stata 11 software.
Results: 38 patients were included, 17 male (45%), mean age 21,7 years (r: 15,6 y-26 y), mean age at diagnosis 10,93 ± 2,54 y (range: 5,5-14,9 y). Mean HbA1 in the last year at the pediatric unit was 8,8% ±1,9 vs. 9,9% ±3,2 at the adult unit (p:0,0048;
CI: 0,35-1,82, T test). Patients with previous poor control worsened during the transition process. Significant variables were assessed through logistic regression; it was found that the metabolic control during the last year at the pediatric unit, and having a treating physician were associated to metabolic outcome some years after the transition process.
Conclusions: the transition process worsened metabolic control of patients, mainly those with poorer control at the pediatric stage and without having a treating physician.
References
Frank ME. Transition into midlife. NAACOGS Clin. Issu Perinat. Womens Health Nurs. 1991; 2(4):421-8.
Bryden KS, Peveler RC, Stein A, Neil A, Mayou RA, Dunger DB. Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study. Diabetes Care. 2001 Sep; 24(9):1536-40.
Fleming E, Carter B, Gillibrand W. The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature. J. Clin. Nurs. 2002 Sep; 11(5):560-7.
Donaghue KC, Fairchild JM, Craig ME, Chan AK, Hing S, Cutler LR, Howard NJ, Silink M. Do all prepubertal years of diabetes duration contribute equally to diabetes complications? Diabetes Care. 2003 Apr; 26(4):1224-9.
Blum RW, et al. Transition from child-centered to adult health-care: systems for adolescents with chronic conditions. J. Adolesc. Health. 1993; 14: 570-576.
Kipps S, et al. Current methods of transfer of young people with Type 1 diabetes to adult services. Diabetic Medicine 19: 649-654, 2002.
Viner R. Transition from pediatric to adult care. Bridging the gaps or passing the buck? Arch. Dis. Child. 1999 Sep;81(3):271-5. Review.
Peters A, Laffel L. The american diabetes association transitions working group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care. 2011 Nov; 34(11):2477-2485.
Reiss J, Gibson R. Health transition: Destination unknown. Pediatrics. 2002; 110:1307-14.
Blum RW. Transition to adult health care: setting the stage. J. Adolesc. Health 1995; 17:3-5.
Viner R. Effective transition from paediatric to adult services. Hospital Medicine May 2000, Vol. 61, N 5: 341-343.
Araujo M, Mazza C. Assessment of risk factors of poor metabolic control in type 1 diabetic children assisted in a public hospital in Argentina. Pediatric Diabetes. 2008 Oct; 9(5):480-7.
Vanelli M, et al. Effectiveness of an uninterrupted procedure to transfer adolescents with type 1 diabetes from the pediatric to the adult clinic held in the same hospital: eight-year experience with the parma protocol. Diabetes Nutr. Metab. 2004 Oct; 17(5): 304-308
Neu A, Lösch-Binder M, Ehehalt S, Schweizer R, Hub R, Serra E. Follow-up of adolescents with diabetes after transition from paediatric to adult care: results of a 10-year prospective study. Exp. Clin. Endocrinol. Diabetes. 2010 Jun;118(6):353-5.
Hochhauser CJ, Rapaport R, Shemesh E, Schmeidler J, Chemtob CM. Age at diagnosis, gender, and metabolic control in children with type 1 diabetes. Pediatr. Diabetes. 2008 Jul 28; 9(4 Pt 1):303-7.
Enzlin P, Mathieu C, Demyttenaere K. Gender differences in the psychological adjustment to type 1 diabetes mellitus: an explorative study. Patient Educ. Couns. 2002 Oct -Nov; 48(2):139-45.
Nakhla M, Daneman D, To T, Paradis G, Guttmann A. Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System. Pediatrics. 2009 Dec;124(6):e1134-41.
de Beaufort C, Jarosz Chobot P, Frank M, de Bart J, Deja G. Transition from pediatric to adult diabetes care: smooth or slippery? Pediatr Diabetes. 2010 Feb;11(1):24-7.
Holmes Walker DJ, Llewellyn AC, Farell K. A transition care programme which improves diabetes control and reduces hospital admission rates in young
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Dirección Nacional de Derecho de Autor, Exp. N° 5.333.129. Instituto Nacional de la Propiedad Industrial, Marca «Revista de la Sociedad Argentina de Diabetes - Asociación Civil» N° de concesión 2.605.405 y N° de disposición 1.404/13.
La Revista de la SAD está licenciada bajo Licencia Creative Commons Atribución – No Comercial – Sin Obra Derivada 4.0 Internacional.
Por otra parte, la Revista SAD permite que los autores mantengan los derechos de autor sin restricciones.
