title: Clinical and Psychosocial Outcomes of a Structured Transition Program Among Young Adults With Type 1 Diabetes.
abstract: OBJECTIVE
  We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care.
  
  
  METHODS
  Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program.
  
  
  RESULTS
  At baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04).
  
  
  CONCLUSIONS
  Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.
authors.affiliation: Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California. Electronic address: beth.pyatak@chan.usc.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pyatak
authors.affiliation: Department of Pediatrics, University of Southern California, Los Angeles, California.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Sequeira
authors.affiliation: Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.
authors.forename: Cheryl L P
authors.initials: CL
authors.lastname: Vigen
authors.affiliation: Department of Pediatrics, University of Southern California, Los Angeles, California.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Weigensberg
authors.affiliation: Department of Pediatrics, University of Southern California, Los Angeles, California; Children's Hospital of Los Angeles, Los Angeles, California.
authors.forename: Jamie R
authors.initials: JR
authors.lastname: Wood
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Lucy
authors.initials: L
authors.lastname: Montoya
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Valerie
authors.initials: V
authors.lastname: Ruelas
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D019090:Case Management / Q000458:organization & administration*; D002908:Chronic Disease / Q000523:psychology; D003863:Depression; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D065228:Non-Randomized Controlled Trials as Topic; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D016730:Program Development; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care / Q000458:organization & administration*; D055815:Young Adult
keywords: Continuity of patient care; Diabetes mellitus; Transition to adult care; Type 1