TOPLINE:

A real-world comprehensive program dedicated to the care of young adults with type 1 diabetes (T1D) led to more meaningful improvements in hospitalization rates, automated insulin delivery uptake, and A1c levels over 4 years usual endocrine care, benefitting even the most vulnerable patients. 

METHODOLOGY:

• Young adulthood is associated with worsening outcomes among underserved patients with T1D. To better help patients during this period, the Supporting Emerging Adults with Diabetes (SEAD) program was developed to offer tailored healthcare transition for young adults with T1D aged 18-35 years.
• The SEAD program provided support that not only addressed medical and nutritional needs but also promoted flexible communication, shared decision-making, T1D education, technology support, and psychosocial help. Patients had appointments with their SEAD providers every week.
• Researchers conducted a longitudinal cohort study over 4 years to compare the effectiveness of the SEAD program with usual endocrine care.
• The primary outcomes included the incidence of annual hospitalizations, diabetes technology uptake, and mean annual change in A1c levels.

TAKEAWAY:

• Researchers included 497 young adults with T1D (mean age, 25 years; 49% public insurance; mean A1c levels, 9.2%) who either enrolled in the SEAD program (n = 332) or received usual endocrine care (n = 165).
• The SEAD program reduced hospitalizations by 64% in young adults with baseline A1c levels > 9%, compared with usual endocrine care, and by 74% in those with both baseline A1c levels > 9% and public insurance.
• Young adults in the SEAD program showed a more rapid uptake of automated insulin delivery technology than those receiving usual endocrine care (P = .017).
• Improvement in the mean A1c levels was substantial among those in the SEAD program (−0.37%), but much less prominent in those receiving usual endocrine care (−0.26%).

IN PRACTICE:

" As the prevalence of youth with diabetes from racial-ethnic minority groups increases in the US, it is critical that programs like SEAD are developed and integrated into real-world care," the authors wrote.

SOURCE:

The study was led by Shivani Agarwal, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine Montefiore Medical Center in New York. It was published online in Diabetes Care.

LIMITATIONS:

This study was not adequately powered to directly evaluate the effect of diabetes technology uptake on improvement in A1c levels and reduction in hospitalization. The analysis of A1c trajectories may have been influenced by participants with varying follow-up durations and inadequate A1c assessments throughout the study period. The study was also designed as a longitudinal cohort study instead of a randomized clinical trial.

DISCLOSURES:

This study was funded by the National Institutes of Health and National Institute of Diabetes and Digestive Kidney Diseases. The authors declared no conflicts of interests.