MON-631 Quality of Life in a Pragmatic Trial of a Type 1 Diabetes Adolescent Transition Program

Introduction: Adolescents with type 1 diabetes (T1D) experience ongoing deterioration in their glycemic control as they transition to young adulthood.(1) Several trials have evaluated possible transition interventions to ameliorate the care gap between pediatric and adult services in T1D care, although it remains unclear which are the most appropriate.(2,3) In this pragmatic study, we sought to determine whether the change in quality of life pre- and post-transition was different between adolescents with T1D accessing a transition program versus those who did not. Methods: Between 2016-2018, we recruited 68 adolescents with T1D at their last pediatric diabetes clinic visit from a tertiary diabetes center without a structured transition program (control group) and 33 from a community-based outreach clinic with a transition program (intervention group) consisting of a transition coordinator, joint transition clinics, and pediatric and adult clinics located in the same building. At the time of transition and at one-year post-transition, we conducted chart reviews and administered surveys, including the SF-8 quality of life questionnaire. Analysis included descriptive statistics and linear regression models. Results: The control and intervention groups had the following characteristics, respectively: age at transition 18.4 years vs. 20.5 years (p<0.001); female 47% vs. 55% (p=0.49); average A1C at the time of transition 8.2% vs. 9.1% (p=0.0053). There was no statistically significant difference in the change in SF-8 scores for each of the eight domains (general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health, and role emotional) between the two groups. However, older age at transition was associated with an improvement in SF-8 vitality domain scores between the pre- and post-transition timepoints (p=0.034). Female sex was associated with a worsening in SF-8 vitality domain (p=0.004) and social functioning domain (p=0.015) scores between the pre- and post-transition timepoints. Finally, higher average A1C in the year prior to transition was associated with a worsening in SF-8 role physical domain scores between the pre- and post-transition timepoints (p=0.002). Conclusions: Quality of life scores in the vitality domain improved in the first year post-transition amongst young adults with T1D who transitioned at an older age, suggesting that a later transition may benefit adolescents with T1D. Additionally, worsening quality of life scores amongst young women and in those with higher pre-transition A1Cs suggest that these populations may require more specialized care at the time of transition. References: 1. Foster et al. Diabetes Technol Ther. 2019;21(2):66-72. 2. White et al. Lancet Child Adolesc Health. 2017;1(4):274-83. 3. Spaic et al. Diabetes Care. 2019;42(6):1018-26.