1220-P: Bridge Into Adulthood—Global Practice on Transitioning Youth with Type 1 Diabetes from Pediatric to Adult Care—Findings from SWEET Database and Center Survey
Bibliographic record
Abstract
Introduction and Objective: The transition process from pediatric to adult type 1 diabetes (T1D) care is poorly explored. We aimed to assess transition for youth living with T1D worldwide. Methods: SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) database was analyzed (2016-2023, centers >20 patients, > 5-year data). Transfer was assumed in T1D patients 14-24 years with no visits for ≥2 years. Age at transfer was evaluated across regions. A survey developed by pediatric and adult diabetologists was distributed to all SWEET centers. Results: Among 33,418 transferred patients (104 centers, 51% male), age at T1D transfer was 18.7 years in Asia/Middle East/Africa, 18.4 in North America/Canada, 18.0 in Europe, 17.2 in Australia/New Zealand and 17.0 in South America (p <0.0001). Female gender and higher HbA1c were associated with earlier transfer (- 0.1 year, p <0.0002; - 0.08, p <0.0001), longer duration and larger centers with later transfer (p <0.0001). Of 160 surveyed centers, 79 responded: 43 in Europe, 20 Asia/Middle East/Africa, 8 North America, 6 South America, 2 Australia/New Zealand, 87% academic, 74% exclusively pediatric, 57% with age limit for pediatric care reimbursement. Annually, 80% of centers transferred <50 patients; 13% of centers transferred at 20+ years, 41% at 18-20, 27% at 16-18 and 9% at 14-16 years (no transfer: 6%). Structured transition was absent in 34% of centers. Key drivers for transfer included age (83% of centers), reimbursement policies (8%) and patient request (4%). Metabolic control (60%), psychiatric comorbidity (63%) and teen pregnancy (59%) influenced transfer, while technology use and T1D complications did not. Conclusion: This study highlights the global variability in T1D transition and the lack of structured transition in many centers. More efforts are needed to enhance transition preparation and a successful transfer for youth with T1D. Disclosure B. Piccini: Advisory Panel; Sanofi. R.W. Holl: None. F. Malik: None. C. de Beaufort: None. N.S. Elbarbary: None. V. Iotova: Other Relationship; Pfizer Inc, Novo Nordisk, AstraZeneca, Rezolute Bio, Medtronic, Novartis Pharmaceuticals Corporation, Novo Nordisk. C. Kanaka-Gantenbein: Research Support; Abbott, Amgen Inc. Advisory Panel; Kyowa Kirin Co., Ltd. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc, Sanofi. H. Kim: None. J.M. Leung: None. J. Mirza: None. L. Preechasuk: None. S. Toni: Consultant; Abbott. Advisory Panel; Sanofi.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".