Transition from Paediatric to Adult Diabetes Services: A Narrative Review of the Years When Control Is Lost
DOI:
https://doi.org/10.5281/zenodo.22260624Keywords:
Transition of care, Type 1 diabetes, Young adults, Loss to follow-up, Glycaemic controlAbstract
Moving from paediatric to adult diabetes services coincides with worsening glycaemic control and increased hospitalisation, and
services have responded by building structured transition programmes. The evidence for them is more mixed than the enthusiasm
suggests. In a comparison of 62 young people transferred either by letter or through a planned handover, the structured group had
better attendance and lower HbA1c at one year, but some cohorts report no change after transfer and others report deterioration.
A retrospective cohort of 118 found 62.5 per cent maintaining regular adult follow-up and 27.5 per cent with discontinuity.
Several features recorded before transfer predicted non-attendance, including higher HbA1c, fewer preceding visits and asking no
questions at the transition appointment. A complication runs through the literature: adolescent control predicts young-adult
control, so much of the deterioration attributed to transition may precede it. Systematic review of 22 interventions concluded that
effective models are yet to be identified.
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