Type 1 diabetes adolescent transition study

AbstractObjectives: Adolescents with type 1 diabetes experience dramatic excursions in blood sugars as they transition to adult care. Trials on single interventions have struggled to demonstrate lasting improvements in clinical outcomes. Thus, the purpose of this study was to evaluate the effect of a multi-component intervention on glycemic control, clinic attendance, and diabetes distress amongst adolescents with type 1 diabetes transitioning to adult health services. Design: Prospective controlled quasi-experimental study. Setting: Adolescents with type 1 diabetes from an urban academic pediatric hospital (control group) and a community regional hospital (intervention group) were recruited and followed for 1 year after their last pediatric diabetes visit. Participants: 101 adolescents with type 1 diabetes transitioning to adult care, including 68 from the control group and 33 from the intervention group. Interventions: The intervention group had access to (1) a diabetes nurse transition coordinator, (2) joint pediatric-adult diabetes clinic visits, and (3) pediatric and adult clinics being in the same building. Those in the control group were referred to an adult diabetes provider at their last pediatric diabetes visit without any formal transition program or additional supports. Primary and secondary outcome measures: The primary outcome was longitudinal change in A1C. The secondary outcomes were number of A1C tests obtained, number of adult diabetes visits attended, time gap between pediatric and adult visits, and diabetes distress. Results: There was a difference in A1C trajectory between the control and intervention groups (base model p=0.004, adjusted model p=0.003). A1C continued to rise in the control group after the transition to adult care, whereas A1C decreased in the intervention group. However, there were no statistically significant differences in the secondary outcomes between the two groups. Conclusion: A multi-component intervention can mitigate the glycemic excursions experienced by adolescents with type 1 diabetes transitioning to adult care.

研究摘要
## 研究目标
患有1型糖尿病的青少年在过渡至成人照护阶段时，会出现血糖的剧烈波动。既往单一干预的临床试验难以证实其对临床结局的持久改善效果。因此本研究旨在评估多组分干预对过渡至成人医疗服务的1型糖尿病青少年的血糖控制、门诊就诊情况及糖尿病痛苦的影响。
## 研究设计
前瞻性对照类实验研究。
## 研究场景
招募来自城市学术型儿童医院（对照组）与社区区域医院（干预组）的1型糖尿病青少年，在其最后一次儿科糖尿病随访后开展为期1年的随访。
## 研究对象
共纳入101名即将过渡至成人照护的1型糖尿病青少年，其中对照组68名，干预组33名。
## 干预措施
干预组可获得三项支持：（1）糖尿病护士过渡协调员；（2）儿科-成人联合糖尿病门诊；（3）儿科与成人门诊位于同一楼宇。对照组仅在最后一次儿科糖尿病随访时被转诊至成人糖尿病诊疗机构，无正式过渡项目或额外支持措施。
## 主要与次要结局指标
主要结局为糖化血红蛋白（A1C）的纵向变化。次要结局包括糖化血红蛋白检测次数、成人糖尿病门诊就诊次数、儿科与成人就诊间隔时间，以及糖尿病痛苦。
## 研究结果
对照组与干预组的糖化血红蛋白变化轨迹存在显著差异（基础模型p=0.004，校正模型p=0.003）。对照组在过渡至成人照护后，糖化血红蛋白水平持续升高；而干预组糖化血红蛋白水平则有所下降。但两组的次要结局指标均未出现统计学显著差异。
## 研究结论
多组分干预可缓解过渡至成人照护阶段的1型糖尿病青少年所经历的血糖波动。