Transition to Adult Care for Youths With Diabetes Mellitus: Findings From a Universal Health Care System

TLDR

The study aimed to describe changes in diabetes‑related hospitalizations and retinopathy screening around transition to adult care and to assess whether different transfer methods improve outcomes. A retrospective cohort of 1,507 young adults with ≥5‑year diabetes duration was followed until age 20 to evaluate outcomes after transition. After transition to adult care, DM‑related hospitalizations rose from 7.6 to 9.5 per 100 patient‑years, with higher rates linked to prior admissions, lower income, female gender, and low physician supply; continuity of physician with an allied health team reduced hospitalization risk by 23%, while eye‑examination rates remained stable (~70%) yet fell short of guideline recommendations.

Abstract

The goals were (1) to describe rates of diabetes mellitus (DM)-related hospitalizations and retinopathy screening before and after transition to adult care and (2) to test whether different methods of transfer of care were associated with improved outcomes.In a retrospective cohort study, we included 1507 young adults with DM of >or=5-year duration and tracked these patients until 20 years of age.DM-related hospitalization rates increased from 7.6 to 9.5 cases per 100 patient-years in the 2 years after transition to adult care (P = .03). Previous DM-related hospitalizations, lower income, female gender, and living in areas with low physician supply were associated with higher admission rates. With controlling for all other factors, individuals who were transferred to a new allied health care team with no change in physician were 23% less likely (relative risk: 0.23 [95% confidence interval: 0.05-0.79]) to be hospitalized after the transition than were those transferred to a new physician with either a new or no allied health care team. The rates of eye examinations were stable across the transition to adult care (72% vs 70%; P = .06). Female patients, patients with higher income, and patients with previous eye care were more likely to have an eye care visit after transfer.During the transition to adult health care, there is increased risk of DM-related hospitalizations, although this may be attenuated in youths for whom there is physician continuity. Eye care visits were not related to transition; however, rates were below evidence-based guideline recommendations.