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Healthcare Utilization in Youth with Type 1 Diabetes Transitioning from Pediatric to Adult Care
Abstracts / Can J Diabetes 40 (2016) S2–S20
independent masked Clinical Events Committees. Mortality was analyzed in the pooled EMPA group versus PBO. Seven thousand and twenty patients (mean age 63.1 years, 71.5% male, BMI 30.6 kg/m2, HbA1c 8.1%) were treated. Median observation time was 3.1 years. EMPA reduced the risk of all-cause mortality by 32% vs. PBO (HR 0.68 [95% CI 0.57, 0.82]; p<0.001). Twothirds of deaths were due to CV causes. EMPA reduced risk of CV death by 38% vs. PBO (HR 0.62 [95% CI 0.49, 0.77]; p<0.001). All 6 categories of CV death occurred in lower or similar proportions of patients on EMPA than PBO. The most frequent category of CV death for which sufficient data were available for the adjudication committee to categorize cause of death was sudden death. The risk of non-CV death was similar in EMPA and PBO groups (HR 0.84 [95% CI 0.60, 1.16]; p=0.285). EMPA in addition to standard of care reduced CV death in patients with T2DM at high CV risk. All categories of CV death contributed to the reduction. The reduction in CV death drove the reduction in all-cause mortality with EMPA.
All-cause mortality CV death* Sudden death Heart failure death Worsening of heart failure Cardiogenic shock Acute myocardial infarction Stroke Ischemic Hemorrhagic Type not assessable Other Presumed CV death† Non-CV death‡ Neoplasms Infections and infestations Respiratory, thoracic and mediastinal disorders Gastrointestinal disorders Other
Placebo (N=2333)
EMPA (N=4687)
194 137 38 22 19 3 11 11 4 6 1 55 53 57 19 17 5 6 15
269 172 53 14 11 3 15 16 10 5 1 74 71 97 50 20 9 2 24
(8.3) (5.9) (1.6) (0.9) (0.8) (0.1) (0.5) (0.5) (0.2) (0.3) (<0.1) (2.4) (2.3) (2.4) (0.8) (0.7) (0.2) (0.3) (0.6)
(5.7) (3.7) (1.1) (0.3) (0.2) (0.1) (0.3) (0.3) (0.2) (0.1) (<0.1) (1.6) (1.5) (2.1) (1.1) (0.4) (0.2) (<0.1) (0.5)
* Based on adjudication. † All deaths not attributed to Clinical Events Committee charter-defined categories of CV death and not attributed to a non-CV cause were presumed CV deaths. ‡ System Organ Class based on MedDRA preferred terms reported by the investigator.
S5
improvement in HbA1c. However, 2 studies demonstrated significant improved adherence to glucose monitoring. Four other studies (total 252 participants, follow-up 3 to 9 months), which used apps plus text messaging, showed a trend toward improved HbA1c. One study showed significant reduction in incidence of severe hypoglycemic events. Most top-rated mobile apps logged parameters relevant to diabetes management, and some provided graphical analysis and set reminders. There is a lack of evidence supporting the role of apps in management of T1DM. This study highlights the need for larger and longer studies to explore the efficacy of apps in T1DM in optimizing outcomes, the populations that would benefit most from these tools, and the resources needed to support mobile apps plus text messaging system. 12 Healthcare Utilization in Youth with Type 1 Diabetes Transitioning from Pediatric to Adult Care SHEHLA N. CHAUDHRY*, ELLEN B. GOLDBLOOM, JULIE MARANGER, BAIJU R. SHAH, MARGARET L. LAWSON†, JANINE MALCOLM Ottawa, ON Background: Type 1 diabetes (T1D) is a common chronic illness of childhood. Transitioning from pediatric to adult care is a time when control may worsen. Development of an effective transition program requires an understanding of healthcare utilization in this population. Objectives: This study compared healthcare utilization in youth with T1D transitioned from pediatric to adult diabetes clinics in the community vs. tertiary care. Methods: We conducted a retrospective chart review of 250 youth transitioned from the Children’s Hospital of Eastern Ontario (CHEO) to The Ottawa Hospital (TOH) or the community between 2004 and 2011. Their subsequent healthcare utilization, ascertained from administrative data, was compared. Results: Thirty per cent of youth were transitioned to the community and 70% to TOH. HbA1c measurements were significantly more frequent in TOH transition group in the first 4 years post-transition. There was no significant difference between those transitioned to the community versus TOH in primary care visits, endocrinology visits, emergency care visits or hospitalizations. Conclusion: Youth with T1D transitioned to a tertiary care centre had more HbA1c measurements per year, but there was no significant difference in healthcare utilization compared with those transitioned to the community.
11 Improving Glycemic Control in Type 1 Diabetes with the Use of Smartphone-Based Mobile Applications: A Systematic Review CATHY SUN*, BERTHA WONG, JANINE C. MALCOLM, MARY-ANNE DOYLE Ottawa, ON Management of type 1 diabetes (T1DM) is often challenging. Smartphone mobile applications (apps) have been shown to help in the management of chronic diseases. However, usefulness of apps in T1DM management has not been established. This systematic review evaluated the evidence supporting the use of stand-alone apps and apps plus text messaging in T1DM management. We also reviewed the characteristics of apps applicable to T1DM management. Medline and Embase were searched to identify studies published before December 2014. We additionally reviewed top-rated relevant apps from Google Play and Apple Apps. From the initial 1727 studies, 8 studies met inclusion and exclusion criteria. Four studies (total 265 participants, follow-up 3 to 6 months), which focused on stand-alone apps, showed no significant
13 Understanding Gaps in Transitions of Care in Emerging Adults with Type 1 Diabetes GEETHA MUKERJI, CHERYL HARRIS-TAYLOR, LEAH DRAZEK, KISHANI SARVANANTHAN, IDAN BERGMAN, JANIS RUSEN, LORRAINE LIPSCOMBE Toronto, ON Background: The transition from pediatric to adult type 1 diabetes (T1DM) care represents a high-risk period for emerging adults (EA). Objectives: To 1) understand transition gaps in care for EA patients with T1DM, 2) understand the needs of this population to inform the design of an improved care model. Methods: Emerging adult patients 18 to 30 years of age with T1DM seen at an academic ambulatory care adult hospital were administered a paper questionnaire at their endocrinology clinic visit between November 2013 and November 2014 to assess baseline demographics, diabetes self-management, transition preparedness and preferences for clinic support. Descriptive analyses were
independent masked Clinical Events Committees. Mortality was analyzed in the pooled EMPA group versus PBO. Seven thousand and twenty patients (mean age 63.1 years, 71.5% male, BMI 30.6 kg/m2, HbA1c 8.1%) were treated. Median observation time was 3.1 years. EMPA reduced the risk of all-cause mortality by 32% vs. PBO (HR 0.68 [95% CI 0.57, 0.82]; p<0.001). Twothirds of deaths were due to CV causes. EMPA reduced risk of CV death by 38% vs. PBO (HR 0.62 [95% CI 0.49, 0.77]; p<0.001). All 6 categories of CV death occurred in lower or similar proportions of patients on EMPA than PBO. The most frequent category of CV death for which sufficient data were available for the adjudication committee to categorize cause of death was sudden death. The risk of non-CV death was similar in EMPA and PBO groups (HR 0.84 [95% CI 0.60, 1.16]; p=0.285). EMPA in addition to standard of care reduced CV death in patients with T2DM at high CV risk. All categories of CV death contributed to the reduction. The reduction in CV death drove the reduction in all-cause mortality with EMPA.
All-cause mortality CV death* Sudden death Heart failure death Worsening of heart failure Cardiogenic shock Acute myocardial infarction Stroke Ischemic Hemorrhagic Type not assessable Other Presumed CV death† Non-CV death‡ Neoplasms Infections and infestations Respiratory, thoracic and mediastinal disorders Gastrointestinal disorders Other
Placebo (N=2333)
EMPA (N=4687)
194 137 38 22 19 3 11 11 4 6 1 55 53 57 19 17 5 6 15
269 172 53 14 11 3 15 16 10 5 1 74 71 97 50 20 9 2 24
(8.3) (5.9) (1.6) (0.9) (0.8) (0.1) (0.5) (0.5) (0.2) (0.3) (<0.1) (2.4) (2.3) (2.4) (0.8) (0.7) (0.2) (0.3) (0.6)
(5.7) (3.7) (1.1) (0.3) (0.2) (0.1) (0.3) (0.3) (0.2) (0.1) (<0.1) (1.6) (1.5) (2.1) (1.1) (0.4) (0.2) (<0.1) (0.5)
* Based on adjudication. † All deaths not attributed to Clinical Events Committee charter-defined categories of CV death and not attributed to a non-CV cause were presumed CV deaths. ‡ System Organ Class based on MedDRA preferred terms reported by the investigator.
S5
improvement in HbA1c. However, 2 studies demonstrated significant improved adherence to glucose monitoring. Four other studies (total 252 participants, follow-up 3 to 9 months), which used apps plus text messaging, showed a trend toward improved HbA1c. One study showed significant reduction in incidence of severe hypoglycemic events. Most top-rated mobile apps logged parameters relevant to diabetes management, and some provided graphical analysis and set reminders. There is a lack of evidence supporting the role of apps in management of T1DM. This study highlights the need for larger and longer studies to explore the efficacy of apps in T1DM in optimizing outcomes, the populations that would benefit most from these tools, and the resources needed to support mobile apps plus text messaging system. 12 Healthcare Utilization in Youth with Type 1 Diabetes Transitioning from Pediatric to Adult Care SHEHLA N. CHAUDHRY*, ELLEN B. GOLDBLOOM, JULIE MARANGER, BAIJU R. SHAH, MARGARET L. LAWSON†, JANINE MALCOLM Ottawa, ON Background: Type 1 diabetes (T1D) is a common chronic illness of childhood. Transitioning from pediatric to adult care is a time when control may worsen. Development of an effective transition program requires an understanding of healthcare utilization in this population. Objectives: This study compared healthcare utilization in youth with T1D transitioned from pediatric to adult diabetes clinics in the community vs. tertiary care. Methods: We conducted a retrospective chart review of 250 youth transitioned from the Children’s Hospital of Eastern Ontario (CHEO) to The Ottawa Hospital (TOH) or the community between 2004 and 2011. Their subsequent healthcare utilization, ascertained from administrative data, was compared. Results: Thirty per cent of youth were transitioned to the community and 70% to TOH. HbA1c measurements were significantly more frequent in TOH transition group in the first 4 years post-transition. There was no significant difference between those transitioned to the community versus TOH in primary care visits, endocrinology visits, emergency care visits or hospitalizations. Conclusion: Youth with T1D transitioned to a tertiary care centre had more HbA1c measurements per year, but there was no significant difference in healthcare utilization compared with those transitioned to the community.
11 Improving Glycemic Control in Type 1 Diabetes with the Use of Smartphone-Based Mobile Applications: A Systematic Review CATHY SUN*, BERTHA WONG, JANINE C. MALCOLM, MARY-ANNE DOYLE Ottawa, ON Management of type 1 diabetes (T1DM) is often challenging. Smartphone mobile applications (apps) have been shown to help in the management of chronic diseases. However, usefulness of apps in T1DM management has not been established. This systematic review evaluated the evidence supporting the use of stand-alone apps and apps plus text messaging in T1DM management. We also reviewed the characteristics of apps applicable to T1DM management. Medline and Embase were searched to identify studies published before December 2014. We additionally reviewed top-rated relevant apps from Google Play and Apple Apps. From the initial 1727 studies, 8 studies met inclusion and exclusion criteria. Four studies (total 265 participants, follow-up 3 to 6 months), which focused on stand-alone apps, showed no significant
13 Understanding Gaps in Transitions of Care in Emerging Adults with Type 1 Diabetes GEETHA MUKERJI, CHERYL HARRIS-TAYLOR, LEAH DRAZEK, KISHANI SARVANANTHAN, IDAN BERGMAN, JANIS RUSEN, LORRAINE LIPSCOMBE Toronto, ON Background: The transition from pediatric to adult type 1 diabetes (T1DM) care represents a high-risk period for emerging adults (EA). Objectives: To 1) understand transition gaps in care for EA patients with T1DM, 2) understand the needs of this population to inform the design of an improved care model. Methods: Emerging adult patients 18 to 30 years of age with T1DM seen at an academic ambulatory care adult hospital were administered a paper questionnaire at their endocrinology clinic visit between November 2013 and November 2014 to assess baseline demographics, diabetes self-management, transition preparedness and preferences for clinic support. Descriptive analyses were