title: Age at Transition from Pediatric to Adult Care Has No Relationship with Mortality for Childhood-Onset Type 1 Diabetes in Japan: Diabetes Epidemiology Research International (DERI) Mortality Study.
abstract: OBJECTIVE
  To follow up Japanese patients with type 1 diabetes for a maximum of 40 years to examine when they transitioned from pediatric care to adult care and to explore whether the attending physician, i.e., pediatrician or internist, was associated with prognosis.
  
  
  METHODS
  Participants consisted of 1,299 patients who had been diagnosed as having type 1 diabetes at less than 15 years old between 1965 and 1979 identified through two nationwide surveys. Patients were classified as having received either pediatric care or adult care at the age of 15 and 30, and were compared for differences in mortality associated with the attending physician.
  
  
  RESULTS
  The attending physicians were confirmed for a total of 1,093 patients at the age of 15. Of these patients, 43.8% and 40.3% received pediatric care and adult care, respectively. Of the 569 patients receiving pediatric care, 74.2%, 56.6%, 53.4%, and 51.3% continued with pediatric care at 20, 30, 40, and 50 years old, respectively. The attending physicians (pediatrician or internist) at the age of 15 and 30 had no significant impact on their survival (P = 0. 892, 0.411, respectively).
  
  
  CONCLUSIONS
  More than half of the patients who had received pediatric care at the age of 15 continued to receive pediatric care even after the age of 30, suggesting that their transition was far from smooth, while the attending physician at the age of both 15 and 30 was not a prognostic factor for mortality. Thus, the timing for transition to adult care in these patients has no relationship with mortality in Japan.
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Onda
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.|Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Rimei
authors.initials: R
authors.lastname: Nishimura
authors.affiliation: Department of Internal Medicine, Morimoto Hospital, Tokyo, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Morimoto
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hironari
authors.initials: H
authors.lastname: Sano
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Utsunomiya
authors.affiliation: Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Tajima
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008875:Middle Aged; D010820:Physicians; D011379:Prognosis; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D060305:Transition to Adult Care