title: Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence.
abstract: OBJECTIVE
  Youth with type 1 diabetes mellitus are at risk for poor glycemic control as they age into adulthood. The aim of this study was to describe sociodemographic and clinical correlates of poor glycemic control associated with the transfer of care from pediatric to adult diabetes providers among a cohort of youth with type 1 diabetes diagnosed in adolescence.
  
  
  METHODS
  Analyses included 185 adolescent participants with recently diagnosed type 1 diabetes in the SEARCH for Diabetes in Youth Study with pediatric care at baseline who were age ≥18 years at follow-up. Demographic and clinical factors were measured by survey and laboratory results. Survival analysis was used to estimate the age of transition. Logistic regression analysis assessed the association of demographic and clinical factors with the transition of care and poor glycemic control at follow-up.
  
  
  RESULTS
  Fifty-seven percent of participants had transitioned to adult diabetes care providers by the follow-up visit. The estimated median age of transition of care was 20.1 years (95% confidence interval 19.8-20.4). Older age, lower baseline glycosylated hemoglobin, and less parental education were independently associated with increased odds of transition. The odds of poor glycemic control at follow-up were 2.5 times higher for participants who transitioned to adult care compared with those who remained in pediatric care.
  
  
  CONCLUSIONS
  Transferring from pediatric to adult care, experienced by more than half the sample, was associated with an increased risk of poor glycemic control at follow-up. These findings suggest that young adults need additional support when moving to adult care.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Box 951752, 22-464 MDCC, Los Angeles, CA 90095-1752, USA. dlotstein@mednet.ucla.edu
authors.forename: Debra S
authors.initials: DS
authors.lastname: Lotstein
authors.forename: Michael
authors.initials: M
authors.lastname: Seid
authors.forename: Georgeanna
authors.initials: G
authors.lastname: Klingensmith
authors.forename: Doug
authors.initials: D
authors.lastname: Case
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Catherine
authors.initials: C
authors.lastname: Pihoker
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Mayer-Davis
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Gilliam
authors.forename: Sarah
authors.initials: S
authors.lastname: Corathers
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.forename: Lawrence
authors.initials: L
authors.lastname: Dolan
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderson
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D060305:Transition to Adult Care / Q000458:organization & administration / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human