Adolescent type 1 diabetes patients face greater risk for heart attacks, strokes, blindness and kidney failure later in life if their transition from pediatric to adult care is not carefully managed, two CU researchers have found. The estimated median age at transition to adult care was 20.1 years and 77 percent of individuals with type 1 diabetes had left pediatric care by age 21. The study suggests that without support, they were 2.5 times more likely to have high blood glucose levels when transitioning from pediatric to adult care

The study is co-authored by Georgeanna Klingensmith, MD, professor, University of Colorado, Barbara Davis Center for Childhood Diabetes and Dana Dabelea, MD, PhD, professor, University of Colorado, Colorado School of Public Health.

“With these results and our Colorado experience, we are developing a program for high school students and young college students to better prepare them to transition into adult care within 2-4 years of graduating from high school. We hope through this program they will have the support and learn the skills they need to successfully transition to the more independent care expected by providers of adult diabetes care,” said Klingensmith. Dabalea added, “Our data highlight the importance of optimal health care transition during a critical period in the life of a teenage with type 1 diabetes. Additional research and programs focusing at improving health care services for this high risk population are urgently needed.”

These data were analyzed from the multi-centered SEARCH for Diabetes in Youth Study, which has tracked children and young adults with diabetes from six centers across the U.S. since 2002. The cohort of youth studied included 185 adolescent and young adults with type 1 diabetes enrolled in the study in the year after their diabetes was diagnosed. Youth included in these analyses were cared for by pediatric diabetes physicians at the time of their initial study visit and were followed for an average of 4.5 years.

Previous research of youth with type 1 diabetes in the United States has primarily looked at youth from one diabetes specialty center or from one geographic area. Other research has looked at youth at one point in time, either before or after leaving pediatric care. This study is the largest national cohort of youth with type 1 diabetes in the U.S. to be followed over a period of time.

The authors did not find that type of insurance (such as public versus private) made a difference in switching to adult care, but they found that older age of the patient, less parental education and lower baseline blood glucose levels were independently associated with increased odds of transitioning to adult care.

The next stage of research is to study young adults who are leaving pediatric care directly as they are aging to see what happens as they get older, and look at how different types of help with the transition to adult care affect outcomes.

Type 1 diabetes is a condition where the body does not produce insulin and cannot convert sugar, starches and other food into energy and is often diagnosed during childhood or adolescence age. It requires life-long access to medical care and intensive daily self-management for people with diabetes to stay healthy.

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This article will be published in the April 2013 issue of the journal Pediatrics.

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Jackie Brinkman
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University of Colorado Denver