This study sought to assess participation rates in a structured programme for adolescents with diabetes transitioning from paediatric to adult care in Auckland, New Zealand. The programme was offered to patients generally aged 14–16 years, with transfer to adult services occurring at 16 years. It consisted of formal educational and social coaching sessions delivered by a multidisciplinary team and led a diabetes nurse specialist. Individualised transition plans were developed in collaboration with each young person and their families. Young people could opt out of the programme, in which case they received routine follow-up in paediatric clinics and were referred to adult services at 16 years.
A total of 476 people with type 1 diabetes transitioned to adult care between June 2006 and June 2016; of these, 408 (86%) participated in the structured programme. Compared with people of white European descent, young people of Māori or Pacific Islander backgrounds were less likely to participate (odds ratios of 0.39 and 0.48, respectively, versus white Europeans). Participation among young people from the most socioeconomically deprived household were also less likely to attend (odds ratio 0.37 versus the least deprived households).
Among the 408 participants in the programme, 96% attended at least one adult diabetes clinic appointment following referral. While only 42% attended in the first 3 months after referral, 87% attended within the first 6 months. The retention rate (defined as attending clinics at least once annually for the first five years after the first adult clinic appointment) was 78%. Although attendance and retention rates at adult clinics were lower in young people who did not attend the structured transition programme, no direct cause-and-effect relationship with the programme can be inferred.
The authors conclude that high rates of adult clinic capture and subsequent retention in adult care following transfer from a paediatric service are possible. However, they also identify additional challenges with providing support for ethnic minorities and young people with low socioeconomic status.
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9 Nov 2023