A pilot randomized controlled trial of a post-discharge program to support emerging adults with type 1 diabetes mellitus transition from pediatric to adult care.
OBJECTIVE
There is a paucity of randomized controlled trials (RCT) examining transition from pediatric to adult care in type 1 diabetes mellitus (T1DM). This study aimed to determine if transition in T1DM is more effective with a comprehensive transition program (CTP) compared with standard clinical practice (SCP).


METHODS
This RCT recruited as young people left pediatric diabetes services. The trial co-ordinator provided CTP participants with standardized telephone communication support at week 1, and 3, 6, and 12 months post-discharge from pediatric care. SCP participants were briefly contacted at 6 and 12 months post-discharge to confirm transfer status; they received no other post-discharge contact as per usual practice. At 12 months, the primary outcomes were engagement and retention in the adult service and secondary outcomes included hemoglobin A1c (HbA1c), diabetes-related hospitalizations, microvascular complication appearance, and global self-worth.


RESULTS
Most CTP participants (11/14) and all SCP (12/12) participants (P = 0.2) transferred to an adult diabetes service; the median time to transfer was 14-15 wk. Overall, participants' frequency of adult diabetes service visits was sub-optimal but their retention in adult care was high. The only group difference was a higher HbA1c at baseline and follow-up in the CTP group. However, a general linear model found that follow-up HbA1c increased by 1.2% for each percentage increase in baseline HbA1c [95% confidence interval (0.4, 1.9; P = 0.01)], independent of treatment group.


CONCLUSIONS
Despite the challenges in recruiting adequate numbers, these findings provide valuable insights for future T1DM transition RCTs that are needed to build a more solid evidence-base in this field.
Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia.|Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.
Katharine S
KS
Steinbeck
Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Vanessa A
VA
Shrewsbury
Department of Adolescent and Transitional Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Vanessa
V
Harvey
Department of Paediatric Endocrinology, The Sydney Children's Hospital at Randwick, Randwick, NSW, Australia.
Kara
K
Mikler
Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.|Institute of Endocrinology and Diabetes, The Sydney Children's Hospital at Westmead, Westmead, NSW, Australia.
Kim C
KC
Donaghue
Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.|Institute of Endocrinology and Diabetes, The Sydney Children's Hospital at Westmead, Westmead, NSW, Australia.
Maria E
http://orcid.org/0000-0001-6004-576X
ME
Craig
Department of Paediatric Endocrinology, The Sydney Children's Hospital at Randwick, Randwick, NSW, Australia.
Helen J
HJ
Woodhead
D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D060305:Transition to Adult Care; D055815:Young Adult
pediatrics; randomized trial; transition to adult care; type 1 diabetes mellitus