Variations in How Youth with Type 1 Diabetes Transition to Adult Care

Background: Young adults with type 1 diabetes are at increased risk for acute complications during their transition from pediatric into adult care. While there is likely considerable variation in how transition care is structured, there is little evidence about the impact that this variation may have on patient outcomes in early adulthood.

Objectives: To determine how young adults with type 1 diabetes transition into adult care in two Canadian provinces: Newfoundland and Labrador (NL) and Ontario (ON); to examine the impact of different models of transition care on outcomes for patients with type 1 diabetes; and to explore ways to better support patients with type 1 diabetes as they transition into adult care.

Design: Mixed methods: Administrative data and qualitative research.

Results: There are significant variations in how the transition to adult care was structured both within and between provinces. The rate of diabetic ketoacidosis (DKA) in ON youth (n=2,525) was higher in those aged 19-21 years compared to 15-17 years (12.0 vs. 9.3/100 person-years, p<0.0018). There was no difference in the rate across transition-age in youth from NL (n=93). In NL, there was no dedicated transition program for much of the province. We helped develop and evaluate a single session transfer clinic. We found that such a clinic is a promising step towards improving patient and parent satisfaction without requiring new staff or significant outlays of new resources. It is unclear whether such a clinic will ultimately impact rates of hospitalizations or DKA.

Conclusion: In two Canadian provinces with different transition models and levels of resources, we found consistency in poor outcomes. Adverse events for this vulnerable population are high in both provinces and efforts to optimize system-level transition care are needed.