MON-220 - Factors Associated With Gaps While Transferring Care Differ for Adolescents and Young Adults With Type 1 Versus Type 2 Diabetes

Young adults with type 1 diabetes (YT1D) frequently face challenges transferring from pediatric to adult care. Known associations with suboptimal transfer outcomes include poor pre-transfer glycemic control as well as lack of education and support before transfer. Young adults with type 2 diabetes (YT2D) are also known to struggle with adult transfer, but little is known about their transfer of care patterns or factors associated with care gaps. We aimed to characterize factors associated with suboptimal transfer for those with T1D and T2D within the same health system.

We conducted a retrospective review of transfer-age patients (≥18 years old) with type 1 (N=636) or type 2 (N=305) diabetes treated over five years at a pediatric center. Demographic variables (sex, age, race/ethnicity, insurance type, Childhood Opportunity Index) and clinical variables (HbA1c, diabetes duration, pump use) were collected. Multivariable logistic regressions, stratified by diabetes type, were conducted using delayed transfer and loss to follow-up as outcomes, using demographic and clinical variables as predictors, and adjusting for covariates. Delayed transfer was defined as first completed adult appointment >6 months after the last pediatric visit. Loss to follow-up was defined as no pediatric visit within the last 6 months and no future scheduled appointments.

Overall, 67% of YT1D in our study had transferred care to an adult provider compared to 38% of YT2D. Of those that transferred to adult care, 48% of YT1D and 46% of YT2D did so within 6 months. For YT1D, patients that were older at their last pediatric appointment and those with a higher HbA1c had higher odds of delayed transfer (OR 1.22, 1.06-1.41, p=0.008, and OR 1.16, 1.04-1.30, p=0.011 respectively) compared to younger patients and patients with lower HbA1c. Patients who used insulin pumps had lower odds of delayed transfer (OR 0.55, 0.35-0.84, p=0.006) compared to patients without pumps. For YT2D, none of the demographic or clinical variables showed significant relationships with delayed transfer. No variables were associated with loss to follow-up in either population.

For YT1D, younger age at time of transfer, insulin pump use, and tighter glycemic control were associated with lower odds of delayed transfer, but these factors were not associated with delayed transfer for YT2D. Future research is needed in larger populations to understand factors associated with transfer outcomes. Prospective data should be collected regarding a wider spectrum of variables that may influence transfer, including transition readiness, family support, and mental health status.

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