Evaluation of a Systems Navigator Model for Transition From Pediatric to Adult Care for Young Adults With Type 1 Diabetes

Objective. To explore expectations for transition to adult care and experiences with transition planning among adolescents and young adults with type 1 diabetes and an A1C >9% at a tertiary care U.S. pediatric center. Methods. We conducted semi-structured interviews in a purposive sample of patients 14–23 years of age who had had type 1 diabetes for at least 1 year and had an A1C >9%. A multidisciplinary team conducted iterative thematic analysis with deductive and inductive coding aided by NVivo software. Results. Fourteen subjects participated (nine adolescents and five young adults, mean age 17.1 ± 3.2 years, 57% male, 79% Caucasian, 14% Hispanic, diabetes duration 8.2 ± 4.6 years, mean A1C 10.0 ± 0.8% for adolescents and 10.1 ± 0.7% for young adults). Qualitative analysis yielded four key themes. The first was lack of formal preparation; participants of all ages demonstrated a lack of preparation for transition and ignorance about the process, describing it as coming “out of the blue.” The second was a desire for delayed and gradual transition; participants wanted to defer being “serious” about transition to a later/uncertain date, with a preference to “wait until I’m older” among all ages. Participants described ideal transition as a gradual, process taking place “a little at a time.” The third was attachment to pediatric providers; participants demonstrated a nearly universal attachment to and “familiarity” with their pediatric diabetes care providers and expressed worries about an “uncomfortable” transition to adult providers. The fourth was concern about an impersonal adult care setting: participants perceived adult care as “formal,” “scarier,” and “tougher,” with increased criticism about poor control; participants expressed fear that adult providers would not “know me” or appreciate “my diabetes journey.” Conclusion. We demonstrated a lack of transition preparation and anxiety about transition and adult care among youth with type 1 diabetes and elevated A1C. Our results may help guide early, iterative pediatric transition counseling, with a special focus on addressing attachment and fears about adult diabetes care.

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Transition from paediatric to adult care: a qualitative study of the experiences of young adults with type 1 diabetes

Scandinavian Journal of Caring Sciences ◽

10.1111/scs.12668 ◽

2019 ◽

Vol 33 (3) ◽

pp. 723-730

Author(s):

Elisabeth Iversen ◽

Beate‐Christin H. Kolltveit ◽

Ingvild Hernar ◽

Jan Mårtensson ◽

Anne Haugstvedt

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Qualitative Study ◽

Adult Care

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Prevalence of dyslipidemia and factors affecting dyslipidemia in young adults with type 1 diabetes: evaluation of statin prescribing

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0383 ◽

2019 ◽

Vol 32 (4) ◽

pp. 327-334 ◽

Cited By ~ 3

Author(s):

Elie Abed ◽

Brenton LaBarbera ◽

Justin Dvorak ◽

Ying Zhang ◽

Joni Beck ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Statin Therapy ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

High Risk Population ◽

Limited Information ◽

Adult Care ◽

Cross Sectional

Abstract Background There is limited information about cardiovascular complications among young adults (YA) with type 1 diabetes mellitus (T1DM) who are transitioning from pediatric to adult care. We aimed to study the prevalence and associated factors of dyslipidemia (DLD) and statin treatment in these patients. Methods We recruited 129 YA with T1DM aged 15–25 years. In a cross-sectional analysis, the prevalence of DLD (low-density lipoprotein cholesterol [LDL-C] ≥ 100 mg/dL, high-density lipoprotein cholesterol [HDL-C] <40 mg/dL [males] or <50 mg/dL [females], total cholesterol [TC] ≥200 mg/dL or triglycerides [TG] ≥150 mg/dL) was reported. Socioeconomic and clinical characteristics were compared between YA with and without DLD. We also assessed statin use among YA with DLD. Results DLD was found in 64% of YA, predominantly increased LDL-C (34.9%). Higher mean glycated hemoglobin (HbA1c) was associated with DLD (p < 0.043). Of all YA who met the criteria for statin therapy, only 42% had one prescribed. Conclusions The prevalence of DLD is high in YA with T1DM and is associated with poor glycemic control, and use of statin therapy in this high-risk population is low.

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Young Adults With Type 1 Diabetes Preparing to Transition to Adult Care: Psychosocial Functioning and Associations With Self-Management and Health Outcomes

Diabetes Spectrum ◽

10.2337/ds19-0050 ◽

2020 ◽

Vol 33 (3) ◽

pp. 255-263

Author(s):

Ana M. Gutierrez-Colina ◽

Sarah Corathers ◽

Sarah Beal ◽

Holly Baugh ◽

Katie Nause ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Health Outcomes ◽

Psychosocial Functioning ◽

Self Management ◽

Transition To Adult Care ◽

Adult Care

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Clinical Care in Young Adults with Type 1 Diabetes After Transition to Adult Care

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2014.07.126 ◽

2014 ◽

Vol 38 (5) ◽

pp. S46

Author(s):

Rashmi Nedadur ◽

Cheril Clarson ◽

Selam Mequanint ◽

Tracy Robinson ◽

Tamara Spaic

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Clinical Care ◽

Transition To Adult Care ◽

Adult Care

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Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes

Global Advances in Health and Medicine ◽

10.1177/2164956118761808 ◽

2018 ◽

Vol 7 ◽

pp. 216495611876180 ◽

Cited By ~ 4

Author(s):

Marc J Weigensberg ◽

Cheryl Vigen ◽

Paola Sequeira ◽

Donna Spruijt-Metz ◽

Magaly Juarez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Theoretical Model ◽

Glycemic Control ◽

Perceived Stress ◽

Group Intervention ◽

Well Being ◽

Adult Care ◽

Diabetes Empowerment

Background The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D. Methods Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of “council” process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods. Results The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT. Conclusions The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully test the role of the underlying theoretical model of action. ClinicalTrials.gov Registration Number NCT02807155; Registration date: June 15, 2016 (retrospectively registered)

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Transfer in care and diabetes distress in young adults with type 1 diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002603 ◽

2021 ◽

Vol 9 (2) ◽

pp. e002603

Author(s):

Jane Sattoe ◽

Mariëlle Peeters ◽

Madelon Bronner ◽

AnneLoes van Staa

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Young Adults ◽

Type 1 Diabetes Mellitus ◽

Short Form ◽

Psychosocial Outcomes ◽

Self Management ◽

Diabetes Distress ◽

Adult Care

IntroductionDiabetes distress (DD) is a serious problem in many people with diabetes and is associated with unfavorable clinical and psychosocial outcomes in children and adults. Little is known about DD in young adults (YAs) with type 1 diabetes mellitus (T1DM) who transferred to adult care. This study aimed to explore the differences between YAs with/without DD regarding transfer experiences, self-management and health-related quality of life (HRQoL).Research design and methodsCross-sectional online questionnaire completed by YAs with T1DM after transfer. DD was measured with the short-form Problem Areas in Diabetes scale. Descriptive analyses were followed by t-tests and χ2 tests to explore differences between the groups with/without DD. Effect sizes were calculated.ResultsOf 164 respondents with mean age 22.7 (±1.56) years, 60.7% was female. The total sample scored low on DD (6.52±4.67; range: 0–17), but 57 (34.8%) had a score ≥8, indicating DD. YAs with DD felt less ready to transfer to adult care than those without DD and scored lower on alliance between pediatric and adult care and reception in adult care. They also reported poorer self-management skills and lower HRQoL in all domains of functioning.ConclusionsMore than one-third YAs experienced DD after transfer; this was associated with less favorable transition, self-management and psychosocial outcomes. Transfer in care seems to be a source of DD. Systematic screening on DD and attention for YAs’ worries is recommended in both pediatric and adult care.

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