Endocrine Abstracts

Background: Moving from childhood to adulthood is a challenging process for individuals with type 1 diabetes (T1D), transition has been defined as the planned movement from pediatric to adult department.

Aim: To assess glucometabolic control, prevalence of autoimmune disorders, and use of glucose sensors in patients with type 1 diabetes after transition to adult care.

Methods: We retrospectively evaluated HbA1c, prevalence of patients using real-time (rt) or intermittently-scanning (is) continuous glucose monitoring (CGM) and prevalence of autoimmune diseases at the time of first evaluation in the adult clinic (baseline) and at the last follow-up. HbA1c values were additionally analyzed in a subgroup of patients at 1 and 3 years after transition.

Results: A total of 132 patients were enrolled between January 2017 and January 2023. We excluded patients without T1D and HbA1c at first visit (final cohort n=102). Median age at transition was 21 years (interquartile range-IQR 20-22 years) and age of diabetes onset was 9 years (IQR 6-11 years). Sex was evenly distributed (50% females). At baseline, the median HbA1c was 56 mmol/mol (IQR 51-67 mmol/mol). The prevalence of autoimmune diseases was 32% for autoimmune thyroiditis, 16% for celiac disease and 5% for other autoimmune disorders. Multiple daily injection therapy was prevalent (69% of the patients), as opposed to insulin pump (31%). Among those, 13% had advanced hybrid closed loop system. With regard to glucose monitoring, 48% of patients were under capillary monitoring, 18% had isCGM, and 34% rtCGM. After baseline visit, 87% of patients had at least one follow-up visit and the median duration of follow-up was 30.4 months (16.7-46.7 months). At the last follow-up, the median HbA1c was 57 mmol/mol (49-64 mmol/mol) and 37% of patients had HbA1c ≤ 53 mmol/mol, while 21% had HbA1c ≤ 48 mmol/mol. The analysis of the subgroup of patients at 1 (n=60) and 3 years (n=28) showed no significant difference in HbA1c compared with baseline HbA1c. An increase in sensor use was found, with 20 new CGM devices positioned, against 3 CGM removed. Autoimmune screening at last follow-up resulted in new diagnosis of 5 autoimmune thyroiditis and 2 autoimmune atrophic gastritis.

Conclusion: Patient with type 1 diabetes showed a stable metabolic control of diabetes after transition to adult care, which occurred in spite of an increase in prescription of CGM devices.