Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System.
OBJECTIVE
The goals were (1) to describe rates of diabetes mellitus (DM)-related hospitalizations and retinopathy screening before and after transition to adult care and (2) to test whether different methods of transfer of care were associated with improved outcomes.


METHODS
In a retrospective cohort study, we included 1507 young adults with DM of >or=5-year duration and tracked these patients until 20 years of age.


RESULTS
DM-related hospitalization rates increased from 7.6 to 9.5 cases per 100 patient-years in the 2 years after transition to adult care (P = .03). Previous DM-related hospitalizations, lower income, female gender, and living in areas with low physician supply were associated with higher admission rates. With controlling for all other factors, individuals who were transferred to a new allied health care team with no change in physician were 23% less likely (relative risk: 0.23 [95% confidence interval: 0.05-0.79]) to be hospitalized after the transition than were those transferred to a new physician with either a new or no allied health care team. The rates of eye examinations were stable across the transition to adult care (72% vs 70%; P = .06). Female patients, patients with higher income, and patients with previous eye care were more likely to have an eye care visit after transfer.


CONCLUSIONS
During the transition to adult health care, there is increased risk of DM-related hospitalizations, although this may be attenuated in youths for whom there is physician continuity. Eye care visits were not related to transition; however, rates were below evidence-based guideline recommendations.
Nakhla
Meranda
M
Division of Endocrinology and Metabolism, Hospital for Sick Children, Toronto, Ontario, Canada. mnakhl@cheo.on.ca
Daneman
Denis
D
To
Teresa
T
Paradis
Gilles
G
Guttmann
Astrid
A
D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000517:prevention & control; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D019472:Universal Health Insurance; D055815:Young Adult