(DCP025) ADHERENCE TO TYPE 1 DIABETES CARE VISITS AFTER TRANSFER FROM PEDIATRIC TO ADULT CARE: A PROSPECTIVE COHORT STUDY

Background: Adolescents with type 1 diabetes (T1D) are at risk of disengaging from regular care, particularly during the transition to adult care. In emerging adults with T1D, our objectives were to 1) describe healthcare utilization after transfer to adult care and 2) determine predictors of gaps in diabetes care visits after transfer from pediatric to adult care.

METHODS AND RESULTS: Prospective cohort study of adolescents with T1D followed for 18 months after their last pediatric diabetes care visit, from 2017 to 2021. We assessed healthcare utilization during follow-up using health administrative data. Primary exposure: delay in establishing adult diabetes care, defined as a gap in care ≥6 months after the last pediatric visit. Our secondary exposures were: self-reported self-efficacy, transition readiness and diabetes distress before transfer to adult care. Primary outcome: gap in adult diabetes care visits after transfer, defined as having a gap ≥6 months after the first adult visit or after the end of the 6-month transfer washout period if no adult visits occurred. Our secondary outcomes were: ≥1 diabetes-related emergency department (ED) visits and ≥1 diabetes-related hospitalizations. We used multivariable logistic regression to examine associations of delay in establishing adult diabetes care and psychosocial factors before transfer with gaps in diabetes care visits within the adult healthcare setting. We adjusted for sex, socioeconomic status, diabetes duration, insulin pump use, diagnosed mental health comorbidities, use of glucose monitoring system and mean HbA1c prior to transfer to adult care.

Results: We included 74 adolescents with T1D. While fifteen (20%) had a delay in establishing adult diabetes care, twenty (27%) had a gap in adult diabetes care visits after transfer. Six participants (8.1%) had at least one ED visit and 1 (1.4%) was hospitalized. We found a direct association between delay in establishing adult diabetes care and subsequent gaps in adult diabetes care visits after transfer (adjusted odds ratio: 29.9; 95% Confidence Interval 5.3-169.9). We did not find evidence of an association between psychosocial measures before transfer and gaps in adult diabetes care visits after transfer.

Conclusion: Healthcare utilization after transfer is sub-optimal in emerging adults with T1D. Delayed transfer of care may place emerging adults at risk of disengaging from adult diabetes care. Further studies should monitor gaps in adult diabetes care on a population level and over longer follow-up periods.