Endocrine Abstracts

Introduction: The transition period to young adult counseling is a crucial period for the diabetic patient. A poor transition exposes them to a risk of disengagement from the health system and mismanagement of diabetes. The objective of this work is to describe the progress of the transition and to deduce the facilitating and restraining elements.

Patients and methods: This were a retrospective study of 120 referred diabetic type 1 patients from the pediatric diabetology department or other centers and managed by the Department of Endocrinology and Diabetology of the IBN ROCHD CHU between 2017 and 2018. The statistical analysis done by the Spss software version 25.0.

Results: The mean age at the time of transition was 15.7±2 years, with a sex ratio of 0.82 H / F, mean glycemic balance (HBA1c) of 9±2.4%. Degenerative complications, Retinopathies (22.5%), Nephropathies (15.8%), Neuropathies (13.3%), HTA (10.8%), Dyslipidemia (5%). The associated pathologies were anemia (12.5%), hypothyroidism (19.2%), Addison’s disease (12.5%). The transition was initiated by the pediatrician (58.3%), the patient himself (24.2%) and the general practitioner (17.5%). The time between receipt of the information and the last pediatric visit was 2.4 months. The ad judged at the right time 75.8% and regarding the feeling 12.5% were worried and 5% curious. Hypoglycemia was present (60%). Hospitalizations after transition 65.8% vs 50%. The treatment regimens were 79.2% basal-bolus and 20.8% premix vs 60% and 40% before transition. We noted a discontinuation of insulin therapy in 35.8% and 18% of patients reported self-monitoring of less than 3 times/week only and an irregular follow-up in 21.7%. The observed failure rate (12%). The facilitators were age at transition, parent support 58.3%, family member 31.7%, and good relationship with the health care team (55%) (P=0.006), r=0.41). And obstacles, poor adhesion to autonomy by fear and worry (16.3%), hypoglycemia, the number of hospitalizations to more than 3 (20%). The transition was beneficial 90%.

Conclusion: Continuity of care is needed to improve the quality of management of diabetic patients and cannot be achieved without a close relationship between pediatric specialists and adult physicians. Hence the need to structure this transition period.