‘The Lost Tribe’: a study of transition care in Lothian

Authors

  • Catriona Kyle Department of Diabetes and Endocrinology, Royal Infirmary Edinburgh, Edinburgh, UK.
  • Alan W Patrick Department of Diabetes and Endocrinology, Royal Infirmary Edinburgh, Edinburgh, UK.
  • Nicola N Zammitt Department of Diabetes and Endocrinology, Royal Infirmary Edinburgh, Edinburgh, UK.

DOI:

https://doi.org/10.15277/bjdvd.2015.018

Abstract

Aims: The management of a chronic disease is challenging during the transition to adulthood. This study examined the follow-up status, glycated haemoglobin (HbA1c) and complication rates in 18–23 year olds with type 1 diabetes mellitus in the Royal Infirmary Edinburgh (RIE) and Roodlands Hospital, Haddington (RHH).

Methods: Subjects were identified by date of birth using Scottish Care Information - Diabetes Collaboration. Follow-up status, median HbA1c, albumin:creatinine ratio, and complications were recorded for the last year of adolescent follow-up and years 1–5 from transition.

Results: 100 subjects were studied; 77 from RIE (39 female) and 23 from RHH (7 female). RIE and RHH respectively lost 20.8% and 34.8% to follow-up. Median HbA1c at RIE fell from 85 mmol/mol to 77 mmol/mol by year 4 and, at RHH, from 79 mmol/mol to 65 mmol/mol by year 4. These HbA1c changes were potentially driven by patients lost to follow-up, who had higher baseline HbA1c (RIE: 91 mmol/mol; RHH: 90 mmol/mol). 12 patients had microalbuminuria after transition to adult care. Retinopathy was recorded in 36% at year 5. There were 0.23 diabetes-related hospital admissions per subject per year and no recorded deaths.

Conclusions: High losses to follow-up are worrying. Those with higher HbA1c appear most at risk. Complication and admission rates are high, underlining the importance of engagement with patients during transition.

References

Scottish Diabetes Survey Monitoring Group. Scottish Diabetes Survey 2012. http://www.diabetesinscotland.org.uk/Publications

Peters A, Laffel L. Diabetes care for emerging adults: Recommendations for transition from paediatric to adult diabetes care systems. American Diabetes Association Transitions Working Group. Diabetes Care 2011; 34:2477-85. http://dx.doi.org/10.2337/dc11-1723

Crawley R, Wolfe I, Lock K et al. Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child 2011; 96:548-53. http://dx.doi.org/10.1136/adc.2010.202473

National Institute for Health and Care Excellence. Clinical Guideline 15. Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. July 2004, updated December 2014

Scottish Intercollegiate Guidelines Network. Section 5.3.7. Guideline 116: Management of Diabetes. March 2010

The Royal College of Physicians of Edinburgh Transition Steering Group. Think Transition: Developing the essential link between paediatric and adult care. Royal College of Physicians 2008. http://www.cen.scot. nhs.uk/files/16o-think-transition-edinburgh.pdf

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Published

2015-06-08

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Section

Learning from practice

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