LAUSR

Abstract Introduction: It has been well-established that, among Adolescents with type 1 diabetes mellitus (T1D), glycemic control deteriorates during the transition from pediatric to adult care.1 This transition is associated with short- and long-term consequences, including microvascular and macrovascular complications, and mortality.2,3 Further, adolescents with T1D who have poor glycemic control pre- transition to adult care continue to have poor glycemic control during and post- transition.4 Identifying patients at highest risk of having poor glycemic control at the time of transition is critical, so providers can intervene and mobilize resources for these adolescents even before they reach the age of transition to adult care. The objective of this study was to determine clinical and demographic characteristics that predict poor glycemic control in adolescents with T1D at the time of transition to adult care. Methods: Between 2016-2018, we recruited 100 adolescents with T1D at their last pediatric visit from a community outreach clinic (n = 32) and a tertiary diabetes clinic (n = 68). We collected the following demographic and clinical data: age at T1D diagnosis, age at transition to adult care, clinic site (community vs. tertiary), sex, ethnicity, insulin regimen, comorbid conditions, last 3 A1C levels, mother and fathers’ marital status and highest education, emergency department visits and hospitalizations in the last year. Study participants also completed the AM I ON TRAC questionnaire and the T1D Diabetes Distress Scale (T1-DDS). We used univariable logistic regression to determine predictors of poor glycemic control (A1C>7.5%). Results: An average of the last three A1Cs was ≤7.5% in 26% of participants, and >7.5% in the remaining 74%. Pediatric care at the community outreach clinic (p=0.042) and female sex (p=0.001) were predictive of an average A1C >7.5% at the time of transition to adult care. Also, those who scored higher on management distress and eating distress at the time of transition were more likely to have poor glycemic control. Conclusions: This study suggests that adolescents accessing care at a community-based outreach clinic and those experiencing higher levels of diabetes distress may be at higher risk of poor glycemic control at the time of transition. Further, female youth with T1D who are approaching transition age have poorer glycemic control. The results of this study can be used by clinicians to identify patients who have the highest risk of having poor glycemic control at the time of transition, allowing them to intervene early and potentially prevent poor outcomes post-transition. References: 1. Miller et al. Diabetes Care. 2015;38(6):971-8. 2. Peters et al. Diabetes Care. 2011;34(11):2477-85. 3. Orchard et al. JAMA. 2015;313(1):45-53. 4. Lotstein et al. Pediatrics. 2013;131(4): 1062-1070.