Endocrine Abstracts

Background and aims: Transition of patients with type 1 diabetes (DM1) from pediatric to adult care is challenging and international guidelines recommend effective transition programs. The aim of this study is to describe our baseline situation, without a structured transition program, and to identify factors associated with worse glycemic outcome.

Materials and Methods: This is an observational, retrospective study of patients with DM1, aged 14 or more on 09/03/2020. We analyzed demographic variables and variables related with metabolic outcomes and complications. A descriptive statistical analysis was performed and comparisons were made pre- and post-transition (Student´s t, Wilcoxon´s test), using R Core Team 2020, 3.6.3. Factors associated with changes in HbA1c and admissions were assessed (Spearman´s R, Mann-Whitney´s test, chi-squared). A P-value < 0.05 was considered significant.

Results: We have currently included 67 patients (58.21% male), 64.2% of whom had adult-care follow-up. HbA1c was 7.7% +/- 1.1 before transition and 8.5% +/- 1.8 (P 0.007) thereafter, despite an increase in their daily insulin dose (0.84 +/- 0.3 UI/kg vs 0.92 +/- 0.3 UI/kg, P 0.008). During transition, 29.8% of patients had at least one admission to the hospital for acute complication, mainly diabetic ketoacidosis (DKA) or hyperglycemia. Patients who had a continuous glucose monitor (CGM) (24.6%) had a significant improvement in HbA1c during transition (-0.54% +/- 1.3) when compared to those without (+ 0.84% +/- 1.53%, P 0.045) and had no admissions for DKA (vs 26.1% without CGM (p 0.028)). Worse glycemic control was also associated with a lower height percentile (Spearman´s R 0.38, p 0.0031), higher levels of triglycerides (Spearman´s R 0.33, P 0.031), LDL-cholesterol (Spearman´s R 0.62, P < 0.001) and total cholesterol (Spearman´s R 0.59, P < 0.001). Admissions due to acute complications were associated with loss of follow-up (P 0.043, OR 4.29, IC 1.19 - 15.41) and a longer time between last pediatric visits and first adult appointment (191 +/- 266.18 vs 449.87 +/- 420.26 days, P 0.037).

Conclusion: Despite the small size of this cohort, we observed a worsening of glycemic and metabolic outcomes during the unstructured transition. We also observed an increased risk for acute complications in patients with loss of follow-up. The association between the use of CGM and improved glycemic control and lower risk of hospital admission has to be interpreted with care, given the retrospective nature of the study, but it could be related with the “booster” education received with the device.