ESPE Yearbook of Paediatric Endocrinology

Pediatr Diabetes. 2018 Apr 25. doi: 10.1111/pedi.12687. [Epub ahead of print]

Transition of patients with chronic diseases from pediatric to adult care has become recognized as an important part of health care provision and its multifaceted challenges are increasingly being studied. This transition period is associated with deterioration of metabolic control and general health in young adults with type 1 diabetes (T1D) (1). The aim of this multicenter study, based on routine care records in the German/Austrian DPV database, was to compare metabolic control, the number of acute complications and the prevalence of microvascular complications in adolescents and young adults with diabetes before and after transfer to adult care.

The study included 1283 young adults with available records of the last pediatric treatment year and the first year after transition to adult care. HbA1c levels increased from 8.95% (74 mmol/mol) before to 9.20% (77 mmol/mol) in the first year after transition. In addition, rates of diabetic ketoacidosis with hospitalization (0.100 to 0.191 per annum, P<0.0001) and severe hypoglycemia (0.23 to 0.46 per annum, P=0.013) doubled during transition. Probably most importantly, microvascular complications increased dramatically between the last visit in pediatric diabetes care and the first visit in adult care. The rise of microvascular complications was unrelated to the duration of transition (short or long) nor to type of transition modality.

It is concluded that transition from pediatric to adult T1D care carries a high risk for impaired metabolic control and microvascular comorbidities. Structured transition programs with case management are likely to improve the transition process and outcomes. The establishment of transition clinics and close cooperation between specialists in pediatric and adult medicine is urgently needed. It is interesting to note that such improvements and changes in diabetes care are demanded by patients and would ensure better uptake of health care services after transfer (1).

Reference: 1. Busse FP, Hiermann P, Galler A, Stumvoll M, Wiessner T, Kiess W, Kapellen TM. Evaluation of patients’ opinion and metabolic control after transfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care. Horm Res. 2007;67:132–8.