Predictors of type 1 diabetes mellitus outcomes in young adults after transition from pediatric care
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BACKGROUND: Type 1 diabetes (T1D) is a common chronic disease. Poor health outcomes are often noted after transfer to adult health care. It is important to determine the predictors of such outcomes to decrease morbidity and mortality. METHODS: The present retrospective study included patients followed for ≥1 year before and ≥1 year after transfer to adult care in a Canadian tertiary diabetes center. Data including demographics, education, comorbidity and pediatric diabetes management-related factors were analyzed as possible independent predictors of adult HbA1c, number of adult diabetes-related hospitalizations, and clinic visits. RESULTS: In all, 102 youths were followed to a mean (±SD) age of 21.8 ± 1.5 years. Predictors of mean adult HbA1c using linear regression were the presence of any comorbidity (0.71%; 95% confidence interval [CI] 0.15-1.27; P = 0.01) and pediatric HbA1c (0.67% per 1% increase in HbA1c; 95% CI 0.51-0.84; P < 0.001). Predictors of hospitalization for hyperglycemia were a history of pediatric hospitalization for hyperglycemia (incidence rate ratio [IRR] 1.20; 95% CI 1.02-1.41; P = 0.029) and high school vs university education (IRR 3.13; 95% CI 1.12-8.73; P = 0.030). CONCLUSION: Young adults with complicated health histories and less education are more likely to experience poor diabetes outcomes in the years after transfer to adult care. These features may highlight youth requiring closer attention or may be targets for intervention.
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