Endocrine Abstracts

JOINT2077

Background: The transition from pediatric to adult care for patients with type 1 diabetes mellitus (T1DM) is a vulnerable period marked by gaps in care continuity and self-management. Limited data exist on patient-reported experiences in low-resource settings.

Objective: To evaluate healthcare accessibility, quality of care, self-management support, and satisfaction during transition in Armenia.

Methods: A questionnaire-based study was conducted with 60 T1DM patients (30% male, 70% female; age 18–≥22 years), stratified by disease duration (≤5, 6–10, ≥11 years) and residence (60% urban, 40% rural). A 25-item survey compared care across four domains: accessibility, quality, self-management support, and outcomes. Qualitative feedback was thematically analyzed.

Results: Accessibility: Visit frequency declined post-transition:33. 3% visited pediatric endocrinologists biannually vs. 21. 7% in adult care, while 23. 3% attended adult clinics less than annually (vs. 3. 3% pediatric). Scheduling adult appointments was harder (28. 4% vs. 10% pediatric, P<0. 05), and provider accessibility dropped sharply (66. 7% pediatric vs. 28. 3% adult, P<0. 01). Quality of Care: Staff knowledge was rated "excellent" by 83. 3% in pediatric vs. 23. 3% in adult care (P<0. 01). Discussions on mental health, nutrition, and insulin management were less frequent in adult care (85% vs. 32% for mental health, P<0. 01). Specialist referrals declined from 75% (pediatric) to 35% (adult, P<0. 01). Self-Management Support: Education on critical skills (insulin devices, carbohydrate counting) declined from near-universal pediatric coverage to 30–50% in adult care. Support for patient independence dropped from 86. 7% ("very supportive" pediatric) to 30% (adult, P<0. 01). Outcomes: Post-transition, only 20% had HbA1c ≤7. 4%, 11. 7% - 7. 5–8. 4%, and 25%-≥8. 5%; 43. 3% did not even check HbA1c in the past year. Hyperglycemia worsened in 52% (vs. 18% improved). Satisfaction: Satisfaction dropped post-transition: 88% were "very satisfied" in pediatric care vs. 25% in adult care, and 97% vs. 63% would recommend their diabetes provider. Only 20% in adult care felt their needs were "always" met.

QualitativeThemes: • Pediatric strengths: Family-centered care, structured and continuous education, tight monitoring and contact with diabetes providers.

• Adult gaps: Fragmented communication, abrupt transitions, inadequate psychosocial support.

• Patient priorities: Financial subsidies for glucometer strips/CGMS and empathetic providers. One participant emphasized, “Doctors must listen and discuss, not just prescribe. ”

Conclusion: T1DM patients in Armenia face significant declines in care quality, self-management education, and provider empathy post-transition, exacerbated by financial barriers and rural disparities. Systemic reforms—gradual transition protocols, subsidized diabetes technologies, and training to foster patient-centered communication—are urgently needed to address these gaps.