Objective
We will recruit 80 YA with T1D to participate in a pilot randomized controlled trial in which we will randomize young adults during their final visit in pediatric T1D specialty care to a standard care control group (SCC) or to receive the new transdisciplinary care for transition (TCT) intervention. Young adults assigned to TCT will participate in three TCT visits during which they will see the TCT team of providers. TCT Visits 1 and 2 will be before the first adult diabetes healthcare visit. These visits will focus on improving transition readiness, establishing care with an adult T1D specialist, and navigating psychosocial barriers to successful transition. TCT Visit 3 will occur after the first adult T1D healthcare visit and will focus on overcoming barriers to satisfactory adult T1D healthcare. Young adults randomized to SCC will proceed with transition to adult diabetes care as usual, without an intervention or support aside from what is typically offered in standard care. Our aims are to 1) examine the feasibility, acceptability, and fidelity of TCT in YA with T1D and 2) examine the preliminary efficacy of TCT versus a standard care control group on HbA1c, transition readiness and success, and continuity of care and explore for an effect on diabetes distress, acute care utilization, and episodes of severe hypoglycemia and diabetic ketoacidosis. We will collect healthcare utilization data, questionnaires, and glycemic levels at baseline and 6 and 12 months later.
Background Rationale
There are many systems and psychological barriers to successful healthcare transition for young adults with type 1 diabetes. Transition coordinators, who address the systems barriers, are the most rigorously studied transition intervention but there is not a lot of evidence that they are effective in reducing barriers to successful healthcare transition. There is some evidence to support for integrated transition clinics to address the psychological barriers to transition and models that include both transition coordinators and integrated transition clinics appear to be the most effective. Existing intervention trials have not tested integrated transition care models versus a standard care control condition and no studies have rigorously tested a transdisciplinary model of transition care in which multiple providers engage in cross discipline training and deliver care conjointly. Also, no studies have included both a transition coordinator and a psychologist as part of the integrated transition team. We plan to fill these literature gaps by establishing a transdisciplinary transition care team consisting of a Diabetes Nurse Educator, Clinical Psychologist, and Transition Coordinator (Social Worker/Case Manager) who will participate in cross discipline training and see young adults jointly at visits.
Description of Project
For most young adults with type 1 diabetes, the transition from pediatric to adult healthcare is characterized by suboptimal glycemic levels, psychosocial concerns, and extended gaps in healthcare, initiating a costly and dangerous trajectory of suboptimal health that often continues into adulthood. Yet, there are few well-researched interventions available to decrease the psychosocial and systems-level barriers that interfere with successful transitions between healthcare settings, so new approaches are needed to support young adults during this high-risk period. If the researchers achieve the aims of this project, the results will be data examining the feasibility, acceptability, and initial efficacy of a novel transdisciplinary care intervention targeting the psychosocial and systems-level barriers of transition to adult healthcare in young adults with type 1 diabetes, which may help them establish healthcare with an adult provider and promote optimal health outcomes.
Anticipated Outcome
We expect that young adults who receive the transdisciplinary care for transition (TCT) intervention will show improvements in HbA1c, transition readiness and success, continuity of care, diabetes distress, acute care utilization, and episodes of severe hypoglycemia and DKA compared to young adults who receive standard care.
Relevance to T1D
Current models of healthcare transition are failing most young adults with type 1 diabetes. An innovative transdisciplinary model of transitional care can better address the psychological and systems barriers to type 1 diabetes management and healthcare and improve outcomes via better assessment of young adult needs and resources, better cross-discipline and young adult-provider communication, and better collaboration with young adults to resolve problems that cross pediatric and adult healthcare settings. The transdisciplinary care for transition model incorporates evidence that both a psychologist and a transition coordinator are effective in improving transition outcomes and evidence that a diabetes nurse educator is effective in delivering medical management of type 1 diabetes. By rigorously validating a novel transdisciplinary care model that applies evidence-based assessment and intervention methods targeting known psychosocial mechanisms, the proposed work is poised to impact how young adults with type 1 diabetes receive care during transition, there by improving treatment engagement, health, and wellbeing