Review article
Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes

https://doi.org/10.1016/j.jadohealth.2016.10.002Get rights and content

Abstract

Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16–23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (−.11 [95% confidence interval: −.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.

Section snippets

Search

Following an a priori protocol [17] and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines [18], we searched six databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, MEDLINE, PsycINFO, and PubMed. Search terms addressed the population ([adolescent or young adult or pediatrics] and [type 1 diabetes]) undergoing transition (transition to adult care or health transition) measuring specific outcomes (hemoglobin A, glycosylated or

Results

Figure 1 provides details regarding the literature search. Of 4,689 records, 2,725 titles and 518 full abstracts were reviewed. During the review of abstracts, there was one title [27] where neither an abstract nor full text could be obtained via library request and was therefore excluded from further review. The full text was reviewed for 81 papers. At this stage in the search, two additional papers were obtained. One was a publication of a study originally retrieved in abstract form only [25]

Discussion

Overall, all but one study [24] reported improvement or maintenance in glycemic control posttransition. While this suggests that transition programs may be effective in maintaining or improving glycemic control during transition, this finding must be interpreted with caution. Most included studies lacked a control group and did not statistically adjust for potential confounding factors such as time. When change in HbA1c was pooled, no differences in glycemic control were found. It may be that

Acknowledgments

A.T.S. wrote the first draft of the manuscript. The authors would like to acknowledge and thank Nelsa S. Avallon Duke, BSN, RN of Columbia University School of Nursing for reading a preliminary draft of the manuscript and Rita Marie John, DNP, EdD, CPNP of Columbia University School of Nursing for reviewing an outline of the manuscript and a draft of our table and figures. No honorariums, grants, or other forms of payments were received for the writing of this manuscript.

Protocol: PROSPERO

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    Conflicts of interest: The authors have no conflicts of interest to disclose.

    Disclaimer: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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