Introduction:
The transition of type 1 diabetic children to adolescents must be multidisciplinary involving paediatrician, endocrinologist, nutritionist and psychologist. It is recommended that this entire team works in close collaboration with the child and his family in order to build a personalized therapeutic project. The adolescent or young adult must face a multitude of challenges. Adolescents are generally unbalanced during the transition period, so the importance of the challenge that should be faced not only by the patient but also by all the health professionals involved in the treatment. The objective of this research was to study the transition modalities adolescent with type 1 diabetes from paediatric to adult diabetic care unit.
Methods:
It is a monocentric, descriptive, cross-sectional and retrospective study. It was conducted at the paediatrics department and the endocrinology department of the main military hospital in Tunis between January 1, 2001 and March 1, 2018. We included children with type 1 diabetes followed up in the paediatrics department then transferred to the adult endocrinology department and having a duration of follow-up in the paediatrics department and in the endocrinology department for at least three years.
Results:
40 cases have been gathered. The average age at the discovery of diabetes was 10 years and 2 months ± 44.63 months. The circumstances of discovery of diabetes is ketoacidosis. The average age at transition was 16 years and 5 months. The average duration of paediatric follow-up was 6.55±3.57 years. Concerning the modalities of the transition, all the children who moved from the paediatric department to the adult endocrinology department were provided with a detailed medical report specifying the clinical, therapeutic and evolutionary characteristics of their disease. No joint consultation between paediatrician and endocrinologist could be carried out. After switching to the adult endocrinology department, treatment was changed in 22 patients (55% of cases). Four children changed the nature of the insulins administered and 18 switched from the double injection scheme to the basal bolus scheme. Mean glycated haemoglobin (Hb1AC) 3 years before transition (HbA1C T-3) was 9.96±1.89% [5.9 to 17.5%]. At three years after the transition, the average glycated haemoglobin (HbA1C T+3) increased to 10.27±1.50% [8 to 14.3%]. The only two factors retained in univariate analysis and significantly associated with good control of diabetes were the practice of regular self-monitoring of blood sugar levels and self-adjustment of insulin doses with a p value < 0.001 for these two parameters. The nature of admission for hypoglycaemia was significantly higher during the period preceding the transition compared to that following it (p=0.03). Hospitalization for ketoacidosis decompensation was significantly more frequent in paediatrics compared to adults (p=0.04). Diabetes was significantly more balanced 3 years before the transition compared to 3 years after the transition with a p value of 0.03.
Conclusion:
In Tunisia, there are few structures focusing on DT1 transition. There are no specific diabetic care units for adolescents. Written and standardized protocols are also rare. This study highlights the insufficiencies of such an approach. It can lead the care givers, the family and the adolescent anxiety and see to poor control of DT1 during this period.
Key words: Type 1 diabetes, Transition, Glycemic control
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