Bridging the Gap to Optimize Care and Outcomes for Youth With Diabetes Between Pediatric and Adult Diabetes Care
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Type1diabetes
- Sponsor
- The Hospital for Sick Children
- Enrollment
- 484
- Locations
- 5
- Primary Endpoint
- HbA1c
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
Adolescents with type 1 diabetes face particular challenges related to having a chronic illness that requires daily intensive self-management and medical follow-up during a period when their social, developmental, educational, and family situations are in flux. When transitioning from pediatric to adult care, over a third of youth have a care gap of >6 months. During this vulnerable period youth are at risk for acute life-threatening complications such as diabetic ketoacidosis, and for poor glycemic control, which confers an increased risk of chronic diabetes complications. Gaps in care may be a result of deficiencies in transition processes causing some young people to be poorly prepared for adult care and dissatisfied with the transition process. Ineffective transition can lead to decreased frequency of diabetes visits and an increased risk of adverse events in young adulthood. Further, risk factors such as psychiatric comorbidity and behavioural problems in adolescents with type 1 diabetes are associated with poor outcomes in early adulthood. Quality improvement initiatives can be designed to optimize care processes such as referral systems to adult diabetes providers.
Our overall objective is to optimize care and outcomes for youth with diabetes as they transition to adult care.
Specific Aim 1: To improve glycemic control in youth around the time of transition from pediatric to adult diabetes care Specific Aim 2: To evaluate the fidelity and quality of a quality improvement intervention designed to improve transition care processes and to identify contextual factors associated with variation in outcomes.
Investigators
Rayzel Shulman
Scientist Track Investigator
The Hospital for Sick Children
Eligibility Criteria
Inclusion Criteria
- •All youth with a clinical diagnosis of type 1 diabetes followed at participating centres at the time of their final pediatric clinic visit between Jan 1, 2018 and Dec 31,
- •Participants will be transitioning to Adult Care (ages \~16-19 yrs).
- •Capacity to read and understand English (we estimate that \>95% of participants will fulfill this requirement).
- •Capacity to consent for themselves.
Exclusion Criteria
- •Individuals with non-type 1 diabetes.
- •Individuals with type 1 diabetes who move out of Ontario within 12 months after their final pediatric visit.
- •Individuals with type 1 diabetes who do not have the capacity to consent for themselves.
Outcomes
Primary Outcomes
HbA1c
Time Frame: HbA1c value up to 12 months after the final pediatric visit.
Hemoglobin A1c
Secondary Outcomes
- Time from the final pediatric visit to the first adult diabetes visit(Time in months up to 12 months after the final pediatric visit)
- Number of Diabetes-related admissions, ED visits, death(number of occurrences up to12 months after the final pediatric visit.)