«Effects of Multidisciplinary and structured education programme on glycaemic control during transition of young adults with type 1 diabetes» Da Porto A., Tommasi E., Cum S., Del Forno E., Caroli E., Manca E., Petrucco A. and R. Candido

TRANSITION High follow-up loss rate Decreased treatment adherence 25% develops psychiatric problems Almost 37% develops at least one diabetes related complication Frequent hospitalization for acute complications Early mortality TRANSITION

Changing responsabilities during transition Childhood Adolescence Adulthood Parents Patient Parents Patient Patient Parents Parents manage the diabetes related diseases Patient Selfmanagement Both manage the diabetes related diseases Developing autonomy in self caring

Aim of the study «Aim of our study was to evaluate the relationship between our model of multidisciplinary structured education programme during transition and post-transition glycaemic control .»

Materials and methods Collected data from 55 patients who have done transition processes in Trieste, from 2010 until 2013. First Visit in Adult Center Socio-demographic data Diabetologic history (duration of diabetes, therapy, complications) Transition data (age of transition, transition gap) Baseline glycaemic control parameters % correct use of CHO count or constant CHO diet Follow Up at 12 months after Multidisciplinary Structured Education Program Variation in glycemic control parameters % CHO Counting % Lost at Follow-up

Materials and methods Glycaemic Control Parameters Hba1c Glycaemic variability (SD of average glucose) and Hypoglycaemia Frequency data were obtained from the analysis of personal blood glucose meters during a period of 90 days. Statistical Analysis: - Descriptive statistics are presented as means and SD or proportion Chi square test was used to compare proportions Multivariate logistic regression model was used to verify tha association between correct management of CHO and glycaemic control parameters at 1 year Correct CHO management defined as correct use of CHO counting or adherence to a costant CHO diet (verified by dietician).

Structured Education Programme Multidisciplinary structured education program was done at the first visit (and carried on during the following months) by the diabetologist, the dietician and the nurse. Correct managing of CHO: CHO count, Constant CHO diet Managing Insulin and CHO supplies during exercise Adequate Hypoglycemia Correction One to one teaching method, printed material support.

Timeline of the educational programme Diabetologist : checks glycaemic control, adjusts therapy (if needed), reinforces education Dietician: checks adherence to CHO management, checks alimentary diary, hypoglycemia correction. reinforces education Nurse: checks correct delivery of insulin, correct use of glucometer, reinforces education Diabetologist Dietician Nurse Diabetologist Dietician Nurse Diabetologist Nurse Diabetologist Nurse T0 1 3 5 6 7 9 12 Months Dietician Nurse Dietician Nurse Dietician Nurse

Baseline clinical characteristics, glycaemic control, complications rate and therapy Variabile N= 55 age 27,8 + 10,1 yr Sex M 32 (59,2%) F 13 (41,8%) Diabetes Duration 17,6 + 9,7 yr Gap transition 6,24 + 9,12 month % CHO Counting 23,6 % % Const CHO diet 11 % % Insulin Pump 14,5% Variabile N= 55 HbA1c 8,1% + 1,2% % Hypoglycaemia 12,6% + 8,2% Glicemic Variability (SD) 83,1 + 23,1 mg/dl Retinopathy 16,4 % Microalbuminuria 9 % Nephropathy 0 % Peripheral Neuropathy 3,6 %

Glycemic Control after education programme Transition GAP I visit -6 month I visit -12 month + 0,39% + 1,8% - 0,15 + 0,81% - 0,72% + 0,65%

Glicemic Control and CHO management after education programme - 1,5 % p NS - 12 % p 0,041

Correct CHO management and glycaemic control at 1 year Fonte Valore Deviazione standard Chi-quadro di Wald Pr > Chi² Wald Limite inf. (95%) Wald Limite sup. (95%) Hba1c 1 anno dopo 0,293 0,365 0,643 0,423 -0,423 1,008 ∆ 6 mesi-1anno 0,488 0,567 0,741 0,389 -0,623 1,599 ∆ ipo -0,534 0,561 0,905 0,341 -1,634 0,566 ∆ var glic -0,366 0,352 1,081 0,298 -1,055 0,323

Predictors of glycaemic control at 1 year Multivariate Linear regression model, dependent variable: Hba1c at 12 months Fonte Valore Deviazione standard t Pr > |t| Limite inferiore (95%) Limite superiore (95%) Hba1c 1 Visita A 0,659 0,152 4,338 0,000 0,346 0,972 Diabetes Duration -0,060 0,224 -0,267 0,792 -0,521 0,401 Age of transition -0,085 0,236 -0,362 0,721 -0,571 Sex 0,048 0,147 0,325 0,748 -0,254 0,350 Gap > 6 moths 0,054 0,146 0,371 0,714 -0,246 0,354 Correct CHO management -0,216 0,151 -1,431 0,165 -0,527 0,095

Conclusions High transition age Acceptable transition GAP Worstening of glycaemic control during transition GAP Insufficent CHO management skills at first adult visit Multidisciplinary structured education programme: - Better CHO management at 1 Year - Improvement in glycaemic control 6. Correct CHO management could be associated to a better glycaemic control al 1 year Educational interventions during transition should be strongly supported, and the best educational strategy should be find out.

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