Aim The aim of our study was to determine – glycaemic control, engagement with health services, emergence of chronic complications, general and psychosocial well being in young adults with type 1 diabetes following transition from paediatric to adult diabetes services.
Background During childhood and adolescence, there is a gradual shift from supervised care delivered by parents and carers to self-care management. A number of publications have highlighted substantial gaps in care during transition.
Methodology Retrospective review of case notes of young adults with type 1 diabetes, 2 years after transition to adult services. Data was obtained from 25 patients.
Results Of the 25 young adults, 4 (16%) had HbA1C of < 58mmols/mol (<7.5%), and 10 (40%) had HbA1C > 80mmols /mol (>9.5%). Mean HbA1C prior to transition was 82.3 mmol/mol (9.68%). 28% of the young adults had psychological comorbidities including low self esteem, significant anxiety, depression, anorexia and agarophobia. 20% had background retinopathy, 28% elevated cholesterol, 4% had microalbuminuria and 4% high blood pressure. 36% were at university, 52% in college and 8% had been excluded from education. Overall DNA rates were significantly high in young people attending transition clinic and young adult clinic. 46% of the young adults were lost in follow up following transfer to adult services.
Conclusion Our study highlights that high HbA1C seen in the transition clinics often translated to poor control in the young adult services. What was particularly worrying was the large number of patients who are lost to follow up at a very crucial stage in life in spite of going through a transition clinic set up. There is an urgent need to put in effective measures to try and reduce these numbers if we are to eventually improve long term outcomes associated with poorly controlled diabetes in this age group. This begets the question whether our current transition services are indeed bridging the gap between the two services or do we need to think of a more effective way of running the diabetes clinics and service in this age group of patients.
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