Adherence to Type 1 Diabetes Care Visits After Transfer From Pediatric to Adult Care: A Prospective Cohort Study
Why this work is in the frame
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Bibliographic record
Abstract
OBJECTIVE: The objectives of this study were to describe health care utilization by adolescents and young adults with type 1 diabetes after transfer from pediatric to adult care and to determine predictors of nonadherence to diabetes care visits after this transition. RESEARCH DESIGN AND METHODS: This was a prospective cohort study following adolescents with type 1 diabetes for 18 months after their last pediatric visit from 2017 to 2021. We assessed health care utilization using Quebec health administrative data. The primary exposure was delay in establishing adult diabetes care, defined as a delay of >6 months between the last pediatric and the first adult diabetes care visit. Secondary exposures were self-reported self-efficacy, transition readiness, and diabetes distress before transferring to adult care. The primary outcome was nonadherence, defined as having gap(s) of >6 months between adult diabetes care visits. Secondary outcomes were one or more diabetes-related emergency department (ED) visit and one or more diabetes-related hospitalization. We used multivariable logistic regression to identify predictors of nonadherence to diabetes care visits after transition to adult care. RESULTS: Fifteen of 74 participants (20%) had delays in establishing adult diabetes care. Twenty participants (27%) were nonadherent to adult diabetes care visits. Six participants (8.1%) had one or more ED visit, and one participant (1.4%) was hospitalized after transferring to adult care. Delay in establishing adult care was associated with subsequent nonadherence to adult diabetes care visits (adjusted odds ratio 29.9, 95% CI 5.3-169.9). CONCLUSION: Health care utilization after transfer to adult care is suboptimal in young adults with type 1 diabetes. Delayed transfer of care puts young adults at risk of disengaging from adult diabetes care.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.003 |
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 it