Strategies Needed to Improve Transition from Pediatric to Adult Diabetes Care in Type 1 Diabetes

A study from investigators at the UCLA David Geffen School of Medicine and Harvard Medical School is calling for greater attention to patients with type 1 diabetes progressing from adolescence to young adulthood.

Results of the study, which assessed nearly 20,000 person-years of data, indicate HbA1c monitoring declines substantially as adolescent patients transition to adulthood, which could lead to a greater risk of adverse events later in life.

“Adolescents and young adults with type 1 diabetes are at-risk of not receiving the recommended levels of annual HbA1c testing, but extent to which this occurs and the degree to which this may due to not accessing care or changes in physicians is poorly understood,” wrote investigators.

Presented at the American Diabetes Association’s 81st Scientific Sessions (ADA 2021) by Lauren Risk, PhD, an Assistant Professor in the Division of General Internal Medicine and Health Services Research at UCLA, the current study sought to assess how provider type might impact HbA1c monitoring. Specifically, investigators hoped to assess whether frequency at which this population does not receive twice-yearly HbA1c tests and the degree to which such rates are associated with age, not accessing care at all, and the types of physicians delivering diabetes care.

To do so, investigators identified a cohort of 9,916 patients with type 1 diabetes aged 13-26 years old who were continuously insured by a large health insurer for 12 months or from during 2012-2016. Among this group, 61.2% reported seeing an endocrinologist, 40.1% reported seeing a pediatrician, and 31.8% reported undergoing HbA1c tests less than twice yearly. Additionally, this patient population provided investigators with 18,927 person-years of follow-up data.

Upon analysis, investigators found the percentage of those not receiving twice-yearly HbA1c tests rose from 17% at the age of 13 years to 40% at the age of 26 years, with this percentage peaking at 45% at 24 years. Additionally, the percent not making any diabetes visits within a calendar year rose from 12% to 17% from the ages of 13 to 26 years old.

At the age of 13 years, pediatric endocrinologists and general pediatricians were the dominant providers, representing 62% and 26%, respectively, of all providers. At the age of 26 years, adult endocrinologists (48%) followed by adult primary care physicians (44%) were the most dominant providers. Results of the investigators’ analyses suggested the most common age at transfers from pediatric to adult physicians appeared to be 18 years for primary care and 19 years for endocrinologists.

In adjusted analysis, results indicated patients receiving care provided by an endocrinologist were more likely to undergo twice-yearly HbA1c testing.

“Observed declines in HbA1c monitoring appear to be related to both not accessing healthcare despite being insured and to transferring the types of providers utilized,” wrote investigators. “Given demographic correlates of accessing subspecialty care and HbA1c monitoring, improving continuity of subspecialty care may mitigate disparities in care quality.”

This study, “HbA1c Monitoring among Adolescents and Young Adults with Type 1 Diabetes: Impact of Diabetes Care Provider Type,” was presented at ADA 2021.