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Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study

Shulman R, Fu L, Knight JC, Guttmann A, Chafe R. CMAJ Open. 2020; 8(1):E69-74. 2020; Feb 11 [Epub ahead of print]. DOI: https://doi.org/10.9778/cmajo.20190019


Background — Transition to adult diabetes care is a high-risk period for acute complications, yet the optimal transition care model is unknown. To gain insight into the impact on health outcomes of system-level transition processes that reflect resourcing differences, we examined acute complications in youth with diabetes across transition in 2 Canadian provinces with different transition care models.

Methods — We used linked provincial health administrative data for Ontario and Newfoundland and Labrador to create 2 parallel cohorts of youth with diabetes diagnosed before age 15 years who turned 17 between 2006 and 2011. Participants were followed until 2015 (maximum age 21 yr). We described rates of and proportion of participants with at least 1 diabetes-related hospital admission at age 15–17 years and 18–20 years, standardized according to material deprivation based on the 2006 Canadian Marginalization Index. We compared diabetes-related admissions at age 15–17 years and 18–20 years in the Ontario cohort.

Results — The cohorts consisted of 2525 youth in Ontario and 93 in Newfoundland and Labrador. In Newfoundland and Labrador, 39 participants (42.0%) were in the lowest socioeconomic quintile, versus 326 (12.9%) in Ontario. The standardized rate of diabetes-related hospital admissions per 100 person-years was 13.5 (95% confidence interval [CI] 12.6–14.4) at age 15–17 years and 14.4 (95% CI 13.5–15.3) at age 18–20 years in Ontario, and 11.4 (95% CI 7.0–15.8) at age 15–17 years and 10.5 (95% CI 6.4–14.6) at age 18–20 years in Newfoundland and Labrador. In Ontario, there was no association between the rate (adjusted rate ratio 1.10, 95% CI 0.94–1.28) or occurrence (adjusted odds ratio 1.03, 95% CI 0.91–1.17) of diabetes-related admissions across transition.

Interpretation — Although posttransition care is delivered differently in the 2 provinces, rates of adverse events across transition were stable in both. Coordinated support during transition is needed to help mitigate adverse events for young adults in both provinces. Delivery of other health care and social services, including primary care, may be influencing the risk of adverse events after transition to adult care.

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