Type1diabetes
Conditions
Keywords
Transition to adult care, Glycemic control
Brief summary
Adolescents with type 1 diabetes face particular challenges related to having a chronic illness that requires daily intensive self-management and medical follow-up during a period when their social, developmental, educational, and family situations are in flux. When transitioning from pediatric to adult care, over a third of youth have a care gap of \>6 months. During this vulnerable period youth are at risk for acute life-threatening complications such as diabetic ketoacidosis, and for poor glycemic control, which confers an increased risk of chronic diabetes complications. Gaps in care may be a result of deficiencies in transition processes causing some young people to be poorly prepared for adult care and dissatisfied with the transition process. Ineffective transition can lead to decreased frequency of diabetes visits and an increased risk of adverse events in young adulthood. Further, risk factors such as psychiatric comorbidity and behavioural problems in adolescents with type 1 diabetes are associated with poor outcomes in early adulthood. Quality improvement initiatives can be designed to optimize care processes such as referral systems to adult diabetes providers. Our overall objective is to optimize care and outcomes for youth with diabetes as they transition to adult care. Specific Aim 1: To improve glycemic control in youth around the time of transition from pediatric to adult diabetes care Specific Aim 2: To evaluate the fidelity and quality of a quality improvement intervention designed to improve transition care processes and to identify contextual factors associated with variation in outcomes.
Interventions
BEHAVIORALData platform +Quality Performance feedback reports
Teams from each of the participating sites will attend the webinars. Each site will share an example of a QI initiative that they are executing and describe the success and challenges.
Sponsors
Canadian Institutes of Health Research (CIHR)
The Hospital for Sick Children
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
An intervention with integrated components
Eligibility
Sex/Gender
ALL
Age
16 Years to 19 Years
Healthy volunteers
No
Inclusion criteria
* All youth with a clinical diagnosis of type 1 diabetes followed at participating centres at the time of their final pediatric clinic visit between Jan 1, 2018 and Dec 31, 2020. * Participants will be transitioning to Adult Care (ages \ 16-19 yrs). * Capacity to read and understand English (we estimate that \>95% of participants will fulfill this requirement). * Capacity to consent for themselves.
Exclusion criteria
* Individuals with non-type 1 diabetes. * Individuals with type 1 diabetes who move out of Ontario within 12 months after their final pediatric visit. * Individuals with type 1 diabetes who do not have the capacity to consent for themselves.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| HbA1c | HbA1c value up to 12 months after the final pediatric visit. | Hemoglobin A1c |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Diabetes-related admissions, ED visits, death | number of occurrences up to12 months after the final pediatric visit. | The occurrence of at least one diabetes-related admissions or emergency department visit or death |
| Time from the final pediatric visit to the first adult diabetes visit | Time in months up to 12 months after the final pediatric visit | identified using physician service claims and defined as the first diabetes office visit by an adult endocrinologist, internist, or family physician |
Countries
Canada
Outcome results
None listed