Youth with diabetes likely to be hospitalized when transitioning to adult care

The transition for youth with diabetes to adult healthcare has an increased risk of hospitalizations, but this can be reduced when there is physician continuity, a new Canadian study reveals. Researchers at the Institute for Clinical Evaluative Sciences (ICES) and The Hospital for Sick Children (Sick Kids) have found young women from poor neighbourhoods were the most likely to be hospitalized after transitioning to adult care without the same physician.

The study of 1,507 young adults with diabetes for at least five years between 1996 and 2004 found:

• Hospitalizations for acute diabetes-related complications increase modestly in youth following the transition from pediatric to adult healthcare services.
• Youth with diabetes who have some continuity of care with their physician following transition to adult care are less likely to be hospitalized than those who experience a complete change in care providers.
• Low-income youth with diabetes are more likely to require hospitalization for acute diabetes-related complications after the transition to adult care.
•  Rates of recommended eye examinations for youth with diabetes are well below evidence-based guideline recommendations, however there are no differences following the transition to adult care services.

“We need to better understand how to ensure a smooth transition to adult healthcare services for children with chronic diseases. This study suggests that some period of continuity with the pediatric physician will improve the health outcomes of youth,” says princial investigator Dr. Astrid Guttmann, ICES researcher, staff paediatrician and project investigator at SickKids and assistant professor of Paediatrics and Health Policy at the University of Toronto.

“It is concerning that youth with diabetes are more likely to be hospitalized for complications of diabetes following the transition to adult care, particularly low-income youth. Our study highlights the need for better coordinated services, especially for high-risk youth,” says lead author Dr. Meranda Nakhla, former research fellow in the Division of Endocrinology at Sick Kids and current pediatric endocrinologist and assistant professor at the Children's Hospital of Eastern Ontario.

The study, “Transition to adult care for youth with diabetes mellitus: findings from a universal healthcare system,” is in the current issue of Pediatrics.

Author affiliations: ICES (T. To, A. Guttmann); Division of Endocrinology and Paediatric Medicine, The Hospital for Sick Children (M. Nakhla, D. Daneman, A. Guttmann); Department of Paediatrics, U of T (M. Nakhla, D. Daneman, A. Guttmann); Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute (D. Daneman, T. To); Dept. of Health Policy, Management and Evaluation, Faculty of Medicine, U of T (T. To, A. Guttmann); Dept. of Epidemiology, Biostatistics and Occupational Health, McGill (G. Paradis).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, is one of Canada's most research-intensive hospitals and one of the world's leading centres dedicated to improving children's health. As innovators in child health, SickKids improves the health of children by integrating care, research and teaching. Our mission is to provide the best in complex and specialized care by creating scientific and clinical advancements, sharing our knowledge and expertise and championing the development of an accessible, comprehensive and sustainable child health system. For more information, please visit www.sickkids.ca. SickKids is committed to healthier children for a better world.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Deborah Creatura
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• Matet Nebres
• Media Relations Manager, SickKids
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• 416-813-6380