THU129 Age At Last Pediatric Type 1 Diabetes Visit Predicts A Successful Transition To Adult Diabetes Care
Authors: Leung Joseph M WS , Chen Leo , Bone Jeffrey , Fox Danya A , Zhang Qian , Amed Shazhan 
Published: October 2023

Disclosure: J.M. Leung: None. L. Chen: None. J. Bone: None. D.A. Fox: None. Q. Zhang: None. S. Amed: None.

Introduction: Adolescents with type 1 diabetes are known to experience a substantial gap when transitioning from pediatric to adult care.1 We have previously validated a pediatric diabetes case definition and differentiating algorithm to create an administrative cohort of individuals diagnosed with type 1 diabetes using linked provincial administrative health data (physician billing, hospital discharge abstracts, and pharmacy dispensations) from British Columbia, Canada. 2 The objective of this study was to identify predictors of successful transition from pediatric to adult diabetes care within this cohort. Methods: Using our administrative cohort, we isolated adolescents who were diagnosed with type 1 diabetes between the ages of 0.5 to 18 years in 1992-2020. We excluded individuals whose last healthcare encounter was at age &lt;14 years (i.e. individuals who had not yet reached adolescence) at the time of data acquisition (2020). Last pediatric visit before transition (LPVBT) was defined as the date of last billing by a pediatrician. First adult visit after transition (FAVAT) was defined as the date of first billing by an adult medicine specialist. We determined age at LPVBT and we calculated duration between LPVBT and FAVAT. ‘Successful transition’ was defined as ≤1 year between LPVBT and FAVAT. We fit logistic regression models to determine predictors of successful transition. Results: We identified 3660 adolescents who were diagnosed with type 1 diabetes in pediatric care. 1615 (44.1%) did not have any adult diabetes visits, while 2045 (55.9%) had one or more adult diabetes visits. Of these, 1405 (38.4%) had FAVAT &gt;1 year after LPVBT and only 640 (17.5%) had a duration between LPVBT and FAVAT of ≤1 year (i.e. successful transition). The mean duration between LPVBT and FAVAT was 3.70 years (median 2.46, IQR = 0.68-5.45). For every 1-year increase in the age at LPVBT, there was an increased odds of successful transition in both the unadjusted analysis (OR 1.809, 95% confidence interval (CI) 1.704-1.925, p&lt;0.001) and when adjusted for sex, age at diagnosis, and urban-rural residency (OR 1.816, 95% CI 1.709-1.933, p&lt;0.001). Those who successfully transitioned were older at their LPVBT (17.74 years, 95% CI 17.62-17.85) compared to those who did not successfully transition (15.10 years, 95% CI 14.99-15.21). Conclusion: Adolescents with type 1 diabetes who remain in pediatric care until at least age 17 are more likely to transition successfully to adult care. Conversely, those who leave pediatric care prematurely are less likely to experience a successful transition. These findings suggest that a key area of focus to improve the transition from pediatric to adult diabetes care is ensuring that youth remain engaged in pediatric care as close to the age of transition as possible.

References: 1. Garvey et al. Endocr Pract. 2013;19(6):946-52. 2. Vanderloo et al. Pediatr Diabetes. 2012;13(3):229-34.

Presentation: Thursday, June 15, 2023