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

Improving transition of care from pediatric to adult endocrinology for adolescents with diabetes

Introduction

Adolescence is a challenging time in a child's life and can be even more stressful for those with a chronic medical condition such as diabetes mellitus. Adolescents and young adults with type 1 and type 2 diabetes experience worsening glycemic levels as they enter adulthood. Data suggest that a formalized health care transition process and beginning transition preparation in early adolescence leads to better transition outcomes.

Methods

The aim of this study was to create a transition of care program for youth with diabetes in a standalone children's hospital by following the Got Transition Six Core Elements of Health Care Transition. First, we implemented a transition of care policy and formalized how we discussed transition of care with patients and families in early adolescence. Further improvements have included assessing readiness to transition, designing a curriculum centered around adolescent-specific issues and how they relate to diabetes management, and forming connections with adult endocrinologists in the area to establish a seamless transition process.

Results

After implementing our program, 90 % (28/31) of our patients indicated they were very or somewhat ready to transition to adult care.

Discussion

We outline our process for developing a transition of care program and provide a practical tool for other pediatric diabetes providers who are interested in implementing a similar program.

Characterizing social and policy determinants of hospital length of stay among paediatric inpatients with diabetes using linked population-based data

Background

Evidence is limited on the non-medical factors influencing hospital length of stay (LOS) among paediatric inpatients with diabetes, notably potential social and policy correlates. This study aimed to characterize the associations of socioeconomic status and health policy environment with diabetes-attributable LOS to help inform accountability monitoring of a provincial comprehensive diabetes strategy aiming to minimize time in hospital among this high-risk population.

Data and methods

This retrospective population-based study drew on multiple linked administrative and geospatial databases among all children aged 18 and under with a diabetes-related hospitalization in the province of New Brunswick, Canada, during the four-year period following implementation of an insulin pump funding program. Multiple linear regression was used to assess the role of access to the public insulin pump resourcing scheme and relative neighbourhood deprivation as predictors of days spent in acute care, controlling for age, sex, and place of residence.

Results

Among the paediatric inpatient population (N = 386), 21% had accessed social resources made available through the insulin pump funding policy and 42% resided in the most materially deprived neighbourhoods. Diabetes-related hospital stays averaged 3.87 days. Paediatric inpatients having accessed resources through the social insurance policy spent significantly fewer days in hospital (1.34 days less [95% CI: 0.63–2.05]) than those who had not, all else being equal. Observed differences in LOS by neighbourhood socioeconomic deprivation were not found to be statistically significant in the multivariate analysis.

Conclusion

Findings from this context of universal medical coverage suggested that public policy for supplemental financing of assistive technologies among children with diabetes may be associated with reduced burden to the hospital system. The causes of socioenvironmental disparities in LOS require further investigation to inform interventions to mitigate preventable patient-level variations in hospital-based health outcomes.