196 - Emerging Adults with Type 2 Diabetes: Understanding Illness Experience and the Transition to Adult Care
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 196 Publication Number: 196.214
Emma Edmondson, University of Pennsylvania, Philadelphia, PA, United States; Emily F. Gregory, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Stephanie M. Garcia, Policylab, Children’s Hospital of Philadelphia, San Francisco, CA, United States; Dava Szalda, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Senbagam Virudachalam, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States
Assistant Professor of Pediatrics Children's Hospital of Philadelphia/University of Pennsylvania Philadelphia, Pennsylvania, United States
Background: Youth with type 2 diabetes (T2DM) tend to be from racial/ethnic minority groups and have lower socioeconomic status, and thus face unique challenges in disease self-management and transition from pediatric to adult care. Little is known about the illness experience of emerging adults with T2DM and the readiness, barriers, and facilitators to transition to adult care. Objective: To describe the illness experience of emerging adults with T2DM, including the barriers and facilitators to transition to adult care, and to explore themes by differences in “transition readiness,” measured by scores on the Transition Readiness Assessment Questionnaire (TRAQ). Design/Methods: We identified eligible participants in the electronic medical record who were at least 18 years old and had T2DM with at least 2 visits with pediatric endocrinology. We conducted semi-structured interviews with a guide based on the health belief model followed by the TRAQ. Recorded telephone interviews occurred from 7/2021-7/2022 and were professionally transcribed. We performed thematic analysis using NVivo 12 and compared themes stratified by mean TRAQ score. Results: Participants (n=25) were predominantly Black (72%), female (68%), had Medicaid insurance (88%) and averaged 18 years (range, 18 – 22). Seven (28%) participants had already transitioned care. The mean TRAQ score was 4.14 (range, 2.25 – 5). Themes from interviews emerged in 4 domains: illness experience, perceived risk of complications, disease management, and transitions of care. Struggling with mental health issues, maintaining a high degree of organization, and experiences with family members (positive and negative) were prominent subthemes. Transition to adult care elicited anxiety and ambivalence. Barriers were emphasized over facilitators. Participants cited confusion about insurance coverage, difficulty finding an adult provider, sadness about leaving pediatric providers, and fear of an uncaring interpersonal environment as barriers. Parental help was the most cited facilitator, followed by support from the pediatric clinical team. Themes did not vary significantly by low or high TRAQ score. Table 1 contains representative quotes.
Conclusion(s): Experiences of emerging adults with T2DM can inform programs to minimize disease exacerbations in this period. Transitions programs must consider factors like mental health, organizational skills, and family issues as central to maintaining disease control. Practical support for identifying new clinicians and intentional welcoming of emerging adults into adult practices may improve care utilization and outcomes in this population.
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