TITLE:
Healthcare-transition risk assessment for emerging adults with diabetes type 1
AUTHORS:
Joey Kaye, Pat Rapley, Gwen Babel, Suzanne Brown
KEYWORDS:
Diabetes; Healthcare Transition; Emerging Adults; Risk Assessment
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.3 No.2,
May
15,
2013
ABSTRACT: AIM: To identify potential risk indicators for
emerging adults transitioning to adult health care. BACKGROUND: Without
maturity, independence, knowledge and motivation to manage their diabetes and
successfully transition to adult healthcare, a proportion of emerging adults
will struggle, leaving themselves vulnerable to diabetes-related complications.
METHODS: Fifty-three emerging
adults (aged 17 - 19 years) recently transitioned from pediatric to adult
healthcare were recruited. Data included demographic, glycated haemoglobin,
Body Mass Index, base-line and 12-month data from four psychosocial measures:
Problem Areas in Diabetes, Diabetes Empowerment Scale, Hospital Anxiety and
Depression Scale and dichotomous questions from the Eating Attitude Test.
Missed appointments were obtained from hospital records. RESULTS: No
significant differences in age, gender, BMI and individual survey scales
between three appointment groups. Median HbA1c in the Sat-1 group was 7% (53
mmol/mol), compared with 8.6% (70 mmol/mol) and 8.5% (69 mmol/mol) respectively
in the Sat-2 and Unsatisfactory groups. A ROC curve analysis and classification
tree analysis identified optimal threshold values for the survey scales and
their linear combinations. These values were used to make comparisons across
two appointment and three HbA1c status groups. The unsatisfactory appointment group
was characterised by statistically higher proportions of participants with (1)
a low score for empowerment alone or in combination (less) with perceived
problems and (2) statistically higher perceived problems and anxiety scores.
CONCLUSIONS: Findings suggest that diabetes self-care confidence, less perception
of diabetes as a problem, could be a useful indicator of future appointment
attendance. Similarly, depression levels could be a useful predictor of
better metabolic control following transition. RELEVANCE TO CLINICAL PRACTICE:
This study offers an innovative use of existing metrics to identify at-risk
emerging adults in a busy clinic. Rather than the emphasis being solely on
blood glucose control, it may be time to consider including psychosocial measures
to identify at-risk individuals at the first appointment in adult healthcare.