A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with Type 1 diabetes aged 15–25 years

Abstract

Aims To determine if a transition support programme for young adults with diabetes could maintain attendance at a specialist clinic, improve diabetes control and reduce acute hospital admissions with diabetic ketoacidosis (DKA) in 15–25‐year‐olds with Type 1 diabetes. Methods A transition coordinator/diabetes educator arranged booking and rebooking of appointments for a young adult diabetes clinic based in an adult hospital between July 2001 and March 2006. An after‐hours phone support service was initiated. Data collected included source of referral, frequency of clinic attendance and HbA_1c at each visit. Numbers of admissions and readmissions with DKA, length of stay and HbA_1c on admission were recorded. Results One hundred and ninety‐one young adults were referred. HbA_1c at initial referral was 9.3 ± 2.17%. HbA_1c significantly improved to 8.8 ± 1.9% (P < 0.001) after a median of five visits with a statistically significant fall in HbA_1c of 0.13% per visit (P = 0.01). The greatest improvements were seen in those with starting HbA_1c > 11% (−2.5 ± 2.3%, P < 0.001). Eighty‐two percent had attended appointments in the last 6 months. There was a significant reduction in DKA admissions falling by 1/3 (P = 0.05), and in readmissions a significant reduction in length of stay (−3.6 days, P = 0.02), over 3.5 years. Conclusions If young adults are appropriately supported in adult services, clinic attendance is maintained, diabetes control is improved and hospital admission rates with DKA are reduced. The cost savings from reduced admissions covered the costs of the programme.