Transfer from paediatric to adult care for young adults with Type 2 diabetes: the SEARCH for Diabetes in Youth Study.
Transfer from paediatric to adult care for young adults with Type 2 diabetes: the SEARCH for Diabetes in Youth Study.
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DOI：
10.1111/dme.13589
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Dabelea D
中科院分区：
文献类型：
--
作者：
Agarwal S;Raymond JK;Isom S;Lawrence JM;Klingensmith G;Pihoker C;Corathers S;Saydah S;D'Agostino RB Jr;Dabelea D
利用青年糖尿病研究，描述与2型糖尿病青年患者从儿科向成人护理转移和血糖控制不良相关的因素。如果年轻的2型糖尿病患者在18岁时在儿科护理期间接受基线搜索访问，并在此后18-25岁进行≥1后续搜索访问，则包括在内。在每次就诊时，收集HbA1c、BMI、自我报告的人口统计和医疗保健提供者数据。用多变量Logistic回归分析人口统计学因素与护理转移和血糖控制差(HbA1c、≥、75%、9.0%)的关系。182名年轻的2型糖尿病患者(男性占36%，少数民族占75%，肥胖占87%)纳入研究。大多数(n=102，56%)报告在随访时转移到成人护理；相当大比例(n=28，15%)报告没有护理，29%没有转移。糖尿病病程[优势比(OR)1.4，95%可信区间(95%CI)1.1，1.8]和确诊年龄(OR 1.8，95%CI 1.4，2.4)预示着离开儿科护理。与性别、年龄、种族/民族或基线糖化血红蛋白水平无关，转移到成人或无治疗与血糖控制不良的可能性有关(成人：或4.5，95%可信区间1.8，11.2；无：或4.6，95%可信区间1.4，14.6)。年轻的2型糖尿病患者在从儿科到成人护理的过程中表现出血糖控制恶化和失访的情况。我们的研究强调了制定量身定做的临床方案和医疗保健系统政策的必要性，以支持日益增长的青年2型糖尿病患者。
To describe factors associated with transfer from paediatric to adult care and poor glycaemic control among young adults with Type 2 diabetes, using the SEARCH for Diabetes in Youth study. Young adults with Type 2 diabetes were included if they had a baseline SEARCH visit while in paediatric care at < 18 years and ≥ 1 follow-up SEARCH visit thereafter at 18–25 years. At each visit, HbA1c, BMI, self-reported demographic and healthcare provider data were collected. Associations of demographic factors with transfer of care and poor glycaemic control (HbA1c ≥ 75 mmol/mol; 9.0%) were explored with multivariable logistic regression. 182 young adults with Type 2 diabetes (36% male, 75% minority, 87% with obesity) were included. Most (n = 102, 56%) reported transfer to adult care at follow-up; a substantial proportion (n = 28, 15%) reported no care and 29% did not transfer. Duration of diabetes [odds ratio (OR) 1.4, 95% confidence interval (95% CI) 1.1, 1.8] and age at diagnosis (OR 1.8, 95% CI 1.4, 2.4) predicted leaving paediatric care. Transfer to adult or no care was associated with a higher likelihood of poor glycaemic control at follow-up (adult: OR 4.5, 95% CI 1.8, 11.2; none: OR 4.6, 95% CI 1.4, 14.6), independent of sex, age, race/ethnicity or baseline HbA1c level. Young adults with Type 2 diabetes exhibit worsening glycaemic control and loss to follow-up during the transfer from paediatric to adult care. Our study highlights the need for development of tailored clinical programmes and healthcare system policies to support the growing population of young adults with youth-onset Type 2 diabetes.
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