Young Australians with type 1 diabetes who switch to adult care before turning 18 have higher blood sugar and wait longer for their first adult appointment, new research shows.

Researchers examined registry data including 784 young people: 342 who transferred to adult care before age 18, and 422 who transferred at 18 or older.

Key findings:

• At their first adult appointment, early transfers had an average HbA1c of 9.3%, compared with 8.8% for those who transferred later.
• The gap between a patient’s last paediatric appointment and first adult appointment averaged 13.5 months for early transfers, against 8.5 months for later transfers.
• Higher HbA1c in adult care was also linked to socioeconomic disadvantage, younger age at transfer, and higher average glucose levels in the three years before transfer.

Dr Steven James.

Lead author Dr Steven James, a senior lecturer in nursing at the University of the Sunshine Coast, and colleagues said the findings were novel because they showed age itself, rather than educational milestones, was driving the timing of transfer.

The authors compared this with a US study, which found transferring before the final year of high school was similarly linked to higher HbA1c than transferring a year after graduation.

The longer wait for early transfers in Australia was concerning, the authors said, though they could not explain why it occurred.

“We could not determine whether youth were receiving interim care via their general practitioner or whether the delay was due to adolescents’ inability to attend or obtain earlier appointments,” they wrote. They said this was an important priority for future research.

The authors said it was unclear whether Australia had enough resources to support early transfer to adult care for young people with type 1 diabetes.

They suggested the link between early transfer and socioeconomic disadvantage might reflect greater independence in this group, but also less financial support and housing instability. Worldwide, low income, lack of health insurance and food insecurity have been linked to poorer blood glucose control, they noted.

The authors called for Australian diabetes groups and researchers to review the financial support available to younger patients moving into adult care.

The study did not capture patients in private healthcare or hospital clinics outside the ADDN registry, and not all patients had extended follow-up in adult services, the authors acknowledged.

Despite these limitations, the authors said the data provided real-world evidence linking early transfer to adult care with higher HbA1c afterwards.

“In the Australian context there is a need for caution with early transfer,” they said. They called for greater attention, in Australia and internationally, to the age of transfer to ensure optimal self-management of type 1 diabetes.

The study, by the Australasian Diabetes Data Network (ADDN), was published in Diabetes Care [[link here].