Health Care Transition in Patients With Type 1 Diabetes Young adult experiences and relationship to glycemic control
Health Care Transition in Patients With Type 1 Diabetes Young adult experiences and relationship to glycemic control
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DOI：
10.2337/dc11-2434
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发表时间：
2012-08-01
期刊：
影响因子：
16.2
通讯作者：
Finkelstein, Jonathan A.
中科院分区：
文献类型：
--
作者：
Garvey, Katharine C.;Wolpert, Howard A.;Finkelstein, Jonathan A.
目的 - 检查新兴成人 1 型糖尿病患者从儿科到成人护理的过渡特征，并评估过渡特征与血糖控制之间的关联。 研究设计和方法 - 我们制定并邮寄了一项调查，以评估年龄 22 至 30 岁、在单一中心接受成人糖尿病护理的新兴成人 1 型糖尿病患者的过渡过程。当前 A1C 数据从病历中获得。结果 - 缓解率为 53%（484 名合格者中的 258 名）。平均过渡年龄为 19.5 +/- 2.9 岁，34% 的人报告在建立成人护理方面存在 >6 个月的差距。过渡的常见原因包括感觉太老（44%）、儿科提供者的建议（41%）和大学（33%）。不到一半的人接受了成人提供者的建议，并且儿科和成人护理之间的时间间隔为 6 个月（调整后的比值比 0.47 [95% CI 0.25-0.88]）。在多变量分析中，转变前 A1C（β = 0.49，P < 0.0001）、当前年龄（β = -0.07，P = 0.03）和教育程度（β = -0.55，P = 0.01）显着影响当前转变后 A1C。过渡准备与过渡后 A1C 没有独立关联（β = -0.17，P = 0.28）。结论 - 当代过渡实践可能有助于防止儿科和成人护理之间的差距，但似乎不会促进 A1C 的改善。应评估更强有力的准备策略以及儿科和成人护理之间的交接。
OBJECTIVE-To examine characteristics of the transition from pediatric to adult care in emerging adults with type 1 diabetes and evaluate associations between transition characteristics and glycemic control.RESEARCH DESIGN AND METHODS-We developed and mailed a survey to evaluate the transition process in emerging adults with type 1 diabetes, aged 22 to 30 years, receiving adult diabetes care at a single center. Current A1C data were obtained from the medical record.RESULTS-The response rate was 53% (258 of 484 eligible). The mean transition age was 19.5 +/- 2.9 years, and 34% reported a gap >6 months in establishing adult care. Common reasons for transition included feeling too old (44%), pediatric provider suggestion (41%), and college (33%). Less than half received an adult provider recommendation and 6 months between pediatric and adult care (adjusted odds ratio 0.47 [95% CI 0.25-0.88]). In multivariate analysis, pretransition A1C (beta = 0.49, P < 0.0001), current age (beta = -0.07, P = 0.03), and education (beta = -0.55, P = 0.01) significantly influenced current posttransition A1C. There was no independent association of transition preparation with posttransition A1C (beta = -0.17, P = 0.28).CONCLUSIONS-Contemporary transition practices may help prevent gaps between pediatric and adult care but do not appear to promote improvements in A1C. More robust preparation strategies and handoffs between pediatric and adult care should be evaluated.