Building the bridge from pediatric to adult diabetes care: making the connection.
The purpose of this study was to evaluate the effectiveness of a structured transition program by measuring clinical and psychometric properties related to transition and adherence to follow-up. Transition of emerging adults with type 1 diabetes can be problematic. This natural progression to adult health care is often delayed, leading to transition at less than optimal times. Implementation of a transition program will improve the transition process for emerging adults with type 1 diabetes.



Mixed-method, prospective longitudinal study involving collaboration between pediatric and adult providers. Subjects age 18 to 28 years were identified for transition. Transition was facilitated via joint appointment with pediatric and adult health care providers. Participants completed pre- and posttransition surveys measuring diabetes-related distress (Diabetes Distress Scale [DDS]), quality of life (Diabetes Quality of Life Youth-Short Form [DQOLY-SF]), and perceived health care provider autonomy support (Health Care Climate Questionnaire [HCCQ]). Primary outcome was adherence to follow-up. Secondary outcomes evaluated correlations in DDS, DQOLY-SF, HCCQ, and A1C. Chart review assessed acute complications, A1C, and adherence to follow-up.



Adherence to follow-up was 100%. This study found that correlations between DQOLY-SF and DDS and correlations between DDS and A1C were highly significant during the pretransition phase. This study also indicated that the same correlations were highly significant following transition. Paired t test indicated a statistically significant reduction in diabetes distress from pre- to posttransition evaluations and an increase in HCCQ. Content comparative analysis of open-ended questions further illustrated issues related to transition.



Use of a structured transition process with joint appointments and transition coordinator improves adherence to follow-up and reduces diabetes-related distress.
Winthrop University Hospital, Winthrop Comprehensive Diabetes Care Center, Garden City, New York (Dr Egan)
Eileen A
EA
Egan
Winthrop University Hospital, Pediatric Diabetes Program, Mineola, New York (Ms Corrigan)
Jean
J
Corrigan
Stony Brook University, School of Nursing, Stony Brook, New York (Dr Shurpin)
Kathleen
K
Shurpin
D000293:Adolescent; D000328:Adult; D057186:Comparative Effectiveness Research; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care; D055815:Young Adult
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human