1. «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

3. 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

4. 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

6. 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 .»

7. 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

8. 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).

9. 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.

10. 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

11. 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 mg/dl
Retinopathy
16,4 %
Microalbuminuria
9 %
Nephropathy
0 %
Peripheral Neuropathy
3,6 %

12. 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%

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

14. 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

15. 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

16. 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.

17. Thank you for your attention