CGM Use, Visits with Diabetes Educator or Nutritionist Reduce Care Gap Between Pediatric and Adult Diabetes

A retrospective analysis of EHR data suggests use of CGM or visits from a diabetes educator or nutritionist were associated with a decrease in gaps between receiving care at a pediatric endocrinology clinic and an adult clinic among patients transitioning from pediatric to adult diabetes.

A new study from Duke University is providing insight into how to improve transitions from pediatric to adult-oriented care for type 1 diabetes mellitus among US patients.

An analysis of electronic health record data from nearly 300 adolescents with type 1 diabetes, results indicate a certified diabetes educator visit, a nutrition visit, or continuous glucose monitor (CGM) use prior to transfer were associated with a shorter gap in care and could reduce risk of adverse events among this patient population.

“The association between certified diabetes educator and CGM use with gap in care should be considered when designing transition programs for adolescents and young adults with type 1 diabetes mellitus,” wrote investigators.

Presented at the American Academy of Clinic Endocrinology’s 30th Annual Meeting (AACE 2021) by Diana Soliman, MD, an endocrinology fellow of Duke University, the current study was designed by Soliman and colleagues from Duke University Health System to assess associations between clinical characteristics, including sociodemographic factors, comorbidities, health care utilization, and device use, on the timing of transfer from pediatric to adult diabetes care. With this in mind, investigators designed their analysis as a retrospective, longitudinal study of patients from endocrinology clinics within the Duke University Health System.

For inclusion in the study, patients needed to have at least 2 pediatric and 1 adult endocrine visit. Of note, patients who took greater than 3 years to transition to adult endocrinology were excluded from analysis. Investigators planned to use multivariable regression to determine the impact of specific covariates on time to transition from pediatric to adult care.

More than 1500 patients were identified in initial searches. Ultimately, 299 patients were identified for inclusion. Of these 54.85% were female and 73.4% were White. When assessing transition, the mean HbA12c at the last pediatric encounter was 9.4%±2.14% and the median number of months to transition was 14.09 months (4.58-43.80).

After adjustment for sociodemographic factors, gap in care was significantly associated with certified diabetes educator visit, nutrition visits, and CGM use prior to transfer. In comparison, the gap in care was extended among those who were not seen by a diabetes educator (relative effect, 1.80; 955 CI, 1.10-3.05; P=.02), those who were not seen by a nutritionist (2.30; 95% CI, 1.53-3.46; P <.01), and those who were not using CGM prior to transfer (1.67; 95% CI, 1.03-2.71; P=.04). Additionally, further analysis suggests HbA1c, insulin pump use, ED visits per year, hospitalizations per year, and comorbidities were not significantly associated with the gap in care.

Investigators noted multiple limitations within their study that could limit the applicability of results.

“The study was limited to a single institution and those who transitioned to adult care. The retrospective nature of the study made it difficult to ascertain if patients transitioned to adult care at another clinic,” wrote investigators.

This study, “Transition from pediatric to adult care in type 1 diabetes mellitus: A longitudinal analysis of clinical characteristics,” was presented at AACE 2021.