Patients with type 1 diabetes transition from pediatric to adult care in Poland—an example from Silesia

Transition from pediatric to the adult care system is an important issue for diabetes management. The objective was to evaluate the transition of young adults with type 1 diabetes (T1DM) from pediatric to adult diabetes care. Questionnaires were sent to all T1DM patients (166), who left pediatric diabetes care in Katowice, Poland (2003–2007). Analyzed parameters included: date of first visit and visit frequency in adult care, HbA1c (mean and final at pediatric care, HbA1c_M and F respectively, reported in questionnaire – HbA1c_Q), and history of acute complications. 132(82.5 %) responses were received. 96(73 %) patients undertook their first visit at adult clinic ≤3 months after finishing pediatric care, 8(6 %) – after 4-6 months, 10(7 %) >6 months, and 12(9 %) remained under the observation of a GP. Subgroup >6 months differed significantly by HbA1c_Q from the <3 months subgroup (10.5 ±3.34 vs. 7.53 ±1.50, P = 0.041). The later the patients take up adult care, the less often they attend visits (P < 0.001). Visit frequency also decreased with age and diabetes duration (P = 0.034 and P = 0.032 respectively). Additionally, patients with fewer visits annually, at all times had poorer glycemic control (HbA1c_M: P = 0.015; HbA1c_F: P = 0.016; and HbA1c_Q: P = 0.012). Changes of HbA1c(d = HbA1c_Q-HbA1c_F) were higher in patients treated with insulin pump therapy compared to multiple daily injections (0.77 ± 1.65 vs. -0.06 ± 1.84; P = 0.045). Nearly 25 % of young adults with T1DM discontinue systematic specialist care after transfer in adult clinics. Patients with poorer glycemic control and fewer visits during pediatric care, as well as those treated with a personal insulin pump, require additional attention during the transition process.