Brief Report
Evaluation of the transition from paediatric to adult diabetic unit for adolescents with type 1 diabetes
Evaluación de la transición desde la Unidad de Diabetes Pediátrica a la de Adultos en adolescentes con diabetes mellitus tipo 1
M. Martín-Frías
, M.A. Álvarez, R. Yelmo, M. Alonso, R. Barrio
Corresponding author
Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
Read
5133
Timeswas read the article
2018
Total PDF
3115
Total HTML
Share statistics
array:23 [ "pii" => "S234128791400101X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2013.10.016" "estado" => "S300" "fechaPublicacion" => "2014-12-01" "aid" => "1461" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2013" "documento" => "article" "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2014;81:389-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1740 "formatos" => array:3 [ "EPUB" => 130 "HTML" => 1235 "PDF" => 375 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1695403313004529" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2013.10.048" "estado" => "S300" "fechaPublicacion" => "2014-12-01" "aid" => "1461" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2014;81:389-92" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3011 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 2177 "PDF" => 715 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Evaluación de la transición desde la Unidad de Diabetes Pediátrica a la de Adultos en adolescentes con diabetes mellitus tipo 1" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "389" "paginaFinal" => "392" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Evaluation of the transition from pediatric to adult diabetic unit for adolescents with type 1 diabetes" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Martín-Frías, M.A. Álvarez, R. Yelmo, M. Alonso, R. Barrio" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Martín-Frías" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Álvarez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Yelmo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alonso" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Barrio" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S234128791400101X" "doi" => "10.1016/j.anpede.2013.10.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791400101X?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403313004529?idApp=UINPBA00005H" "url" => "/16954033/0000008100000006/v1_201412040021/S1695403313004529/v1_201412040021/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S2341287914001045" "issn" => "23412879" "doi" => "10.1016/j.anpede.2013.10.018" "estado" => "S300" "fechaPublicacion" => "2014-12-01" "aid" => "1469" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2014;81:393-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2217 "formatos" => array:3 [ "EPUB" => 137 "HTML" => 1638 "PDF" => 442 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Vasa praevia rupture in velamentous insertion of the umbilical cord: The importance of prenatal diagnosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "393" "paginaFinal" => "395" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rotura de vasa previa en una inserción velamentosa de cordón umbilical. Importancia del diagnóstico prenatal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 772 "Ancho" => 983 "Tamanyo" => 139623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic view of the placenta.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J. Pérez Rodríguez, E. de Frutos Moneo, S. Nieto Llanos, J. Clemente Pollán" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Pérez Rodríguez" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "de Frutos Moneo" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Nieto Llanos" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Clemente Pollán" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914001045?idApp=UINPBA00005H" "url" => "/23412879/0000008100000006/v1_201412100926/S2341287914001045/v1_201412100926/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2341287914001070" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.01.004" "estado" => "S300" "fechaPublicacion" => "2014-12-01" "aid" => "1548" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2014;81:383-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2337 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 1817 "PDF" => 375 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Has the use of antipyretics been modified after the introduction of different concentrations of ibuprofen into the market?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "388" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Se ha modificado el uso de antitérmicos tras la introducción de ibuprofeno a diferentes concentraciones?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 998 "Ancho" => 1579 "Tamanyo" => 48387 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Type of usage of the different antipyretics by number of patients. Metamizole was only used in one patient and was not represented (over<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>overdose, under<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>underdose). The difference in the frequencies of ibuprofen under- and overdosing between ibuprofen and paracetamol were statistically significant.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.P. García Blanes, P. Rodríguez-Cantón Pascual, C. Morales-Carpi, F.J. Morales-Olivas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C.P." "apellidos" => "García Blanes" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rodríguez-Cantón Pascual" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Morales-Carpi" ] 3 => array:2 [ "nombre" => "F.J." "apellidos" => "Morales-Olivas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314000691" "doi" => "10.1016/j.anpedi.2014.01.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314000691?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914001070?idApp=UINPBA00005H" "url" => "/23412879/0000008100000006/v1_201412100926/S2341287914001070/v1_201412100926/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Evaluation of the transition from paediatric to adult diabetic unit for adolescents with type 1 diabetes" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "389" "paginaFinal" => "392" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Martín-Frías, M.A. Álvarez, R. Yelmo, M. Alonso, R. Barrio" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Martín-Frías" "email" => array:1 [ 0 => "mmartinf.hrc@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Álvarez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Yelmo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alonso" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Barrio" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la transición desde la Unidad de Diabetes Pediátrica a la de Adultos en adolescentes con diabetes mellitus tipo 1" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The transition to adult diabetes units (ADUs) takes place during adolescence, a particularly critical period of life characterised by specific physiological and psychological changes that increase the risk of development and progression of chronic complications and of admissions related to type 1 diabetes mellitus (T1D).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The transition to ADU is a period with heightened risk of loss of followup and development of complications.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is no systematic approach to this transition, and the way it is managed is influenced by the resources of each healthcare facility.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> The transfer process plays an essential role in the control and followup of these patients.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> There is evidence showing that the implementation of specific transitional care programmes has a positive cost–benefit ratio.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> There is no unified approach to the transfer of patients from paediatric diabetes units (PDUs) to ADUs in Spain.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of our study was to analyse metabolic control and degree of satisfaction in a group of patients with T1D who had been followed up in our paediatric diabetes unit (PDU) following transition to the ADU.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a retrospective study in 49 adult patients (43% female) with a T1D diagnosis that had been transferred to an ADU from our PDU. The study was approved by the ethics committee of our institution.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The transfer was planned at around 18 years of age. Before the transition, the patient received refresher education on diabetes, and a final assessment of chronic complications was made. Patients were transferred to different ADUs depending on their assigned service area, if they lived in Madrid, or in their cities of origin, so patients were not all transferred to the same ADU.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We obtained the paediatric data from the standardised medical records of our PDU, and the follow-up data from the ADU by means of a phone or electronic mail survey. We studied the age at diagnosis and at transition to adult care (in years), the duration of followup (in years), the levels of HbA1c (%), body mass index (BMI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>weight/height<span class="elsevierStyleSup">2</span>, expressed in kg/m<span class="elsevierStyleSup">2</span>), the presence or absence of complications (acute [severe hypoglycaemia, ketoacidosis] and chronic) and the type and frequency of patient followup at the time of transition and at the time of the study. We also asked patients to provide a qualitative assessment of their degree of satisfaction (very good, good, fair, or poor) for each unit.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Metabolic control was assessed using HbA1c levels determined by high-performance liquid chromatography (HPLC-Menarini, standardised to DCCT/IFCC, normal range 5.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4%). According to international criteria, we defined good metabolic control as HbA1c.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In our descriptive analysis we used absolute and relative frequencies to express qualitative variables and the mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation to express quantitative variables. We used parametric paired sample tests to compare the variables. The statistical analysis was performed with the SPSS PC software for Windows, version 17.0. We set the level of statistical significance at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The mean age at diagnosis of T1D was 8.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.6 years, and the mean age at transition to the ADU was 19.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.8 years. The mean duration of followup in the PDU was 10.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0 years, and the mean followup in adults was 4.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.6 years, with an overall duration of followup of 15.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.7 years. The characteristics of patient control and followup are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Once the patients transitioned, 93% were followed up in the public healthcare system; 84% attended an ADU; 10% were monitoring or followed-up by their primary care physician; and 6% reported having dropped out of medical care. We found no significant differences in their BMI (23.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.3 vs. 23.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.0<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">None of the patients had any complications at the time of transition from paediatric care. Among the adult patients, 29% could not provide information about their diabetes complications, and 6% did not know what their last HbA1c value was. A patient reported having had mild retinopathy and another diabetic neuropathy. When it came to acute complications, there were a total of 5 episodes (in 4 patients) of severe hypoglycaemia and 3 cases (in 3 patients) of diabetic ketoacidosis in the paediatric followup; while in the adult followup patients reported three episodes of severe hypoglycaemia (3 patients, one with an episode when the patient was of paediatric age) and one of ketoacidosis (in a patient that had had a similar complication in the PDU). Metabolic control declined in 52% of patients, with rising levels of HbA1c (+0.79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.70%), and the percentage of patients with HbA1c levels below 7.5% was lower when they were assessed as adults. However, we found no significant differences between the mean levels of HbA1c in the PDU and the ADU (7.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8% at the time of transition, and 7.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9% at the time of the study). Based on international criteria, metabolic control in the PDU was good in 56% of the patients and poor in 4% of patients, vs. 52% and 10%, respectively, in ADUs. We did not find a correlation between the duration of disease and the levels of HbA1c at any of these times.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The degree of satisfaction with the PDU was good or very good in 96% of patients; with the ADU, it was good or very good in 74% of the patients; and 66% of patients perceived the overall care as worse after transferring from the PDU.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">The efforts of patients, family, and the diabetes teams need to be coordinated to enable youths with chronic diseases diagnosed during childhood to optimise their ability to gradually assume responsibilities in the management of these conditions without a decline in their overall health.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This is particularly important in patients with T1D.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Different studies have demonstrated that metabolic control, a key marker of the risk of developing complications secondary to DM1,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> is poor in some adolescents as they transition into adulthood.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Several factors seem to be at play in the poorer metabolic control observed in this age group, including the physical and psychological changes that are taking place in these patients, and their contact with and followup in diabetic units.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,16</span></a> A recent study showed that transition to the ADU increases the risk of poor metabolic control in patients recently diagnosed with DM1.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Compared to the study of Lotstein et al, our patients had better metabolic control at transition: mean HbA1c levels of 7.3% vs. 7.5%, with poor control in only 4% vs. 11% of patients.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Compared to the longitudinal study of Petitti et al., 56% of our patients had levels of HbA1c below 7.5% at transition to the ADU our patients, vs. 32% of their patients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In our study, we observed a decrease in the number of patients with levels of HbA1c below 7.5% after transition to the ADU.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,17</span></a> We did not observe an increased number of admissions attributable to acute complications in the adult group, unlike what has been described in other series.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It is worth noting that 16% of patients were lost to followup in diabetes units, that less than half received ongoing support by a diabetes educator, and that only a quarter of the patients had access to their ADU 24<span class="elsevierStyleHsp" style=""></span>h a day. We believe that all these factors contributed to the differences in the degree of satisfaction reported by our patients. We think that the decline in metabolic control can be partly due to differences between paediatric and adult care in the management of DM1.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These results evince the need to improve the process of transfer of adolescents with T1D to the ADU.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Among the limitations of our study are the small sample size, that all our patients came from the same PDU, that the subsequent followup was conducted in different adult facilities, and that the metabolic control data for the ADU are self-reported by patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">To conclude, we believe that the transition of paediatric patients with DM1 to ADUs requires better planning in order to optimise their short-term care and to prevent declines in metabolic control and losses to followup.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres388685" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Patients and methods" 4 => "Results" 5 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec367272" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres388684" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Pacientes y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec367271" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-13" "fechaAceptado" => "2013-10-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec367272" "palabras" => array:5 [ 0 => "Type 1 diabetes" 1 => "Transition" 2 => "Paediatric diabetes unit" 3 => "Adult diabetes unit" 4 => "Follow-up" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec367271" "palabras" => array:5 [ 0 => "Diabetes mellitus tipo 1" 1 => "Transición" 2 => "Unidad de diabetes pediátrica" 3 => "Unidad de diabetes de adultos" 4 => "Seguimiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The transition between paediatric and adult care for young people with type 1 diabetes (T1D) is often poorly managed, with adverse consequences for health, as well as a decrease in the follow-up.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To analyse the metabolic control and the degree of satisfaction in a group of patients with T1D after being transferred from the paediatric diabetes unit (PDU) to adult diabetes unit (ADU).</p> <span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective study in a cohort of 49 patients (43% female) with T1D. The age at diagnosis and transfer to ADU, time of onset of the disease, metabolic control (HbA1c), presence of diabetic complications and characteristics of medical follow-up were analysed using the statistics program: SPSS, version 17.0.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Mean age at diagnosis 8.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.6 years and transfer to ADU 19.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.8 years. Mean time since onset of T1D in paediatrics, adults and overall: 10.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0, 4.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.6 and 15.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.7 years, respectively. The 6% of adult patients were not being medically tracked. Among adults, 25% did not provide data about chronic complications, and 6% did not know their last HbA1c. The metabolic control after their transfer to the ADU worsened in 52% of the patients (HbA1c +0.79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.70%). No correlation was found between the time since onset and the HbA1c value. Degree of satisfaction was either good or very good in 96% of patients in the PDU and 74% in ADU.</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Better planning for the transfer of paediatric patients with T1D to ADU is highly recommended, in order to avoid deterioration of control and/or loss of follow-up.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el control metabólico y grado de satisfacción en un grupo de pacientes con DM1 tras cambiar de Unidad (Pediátrica [UDP], Adultos [UDA]).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Pacientes y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo: 49 pacientes, 43% mujeres. Analizamos: edad al diagnóstico y paso a adultos, tiempo evolución, control metabólico (HbA1c), complicaciones diabéticas y características del seguimiento. Estudio estadístico: programa SPSS-versión-17.0.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Edad media<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>desviación estándar al diagnóstico 8,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,6 y en transferencia 19,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1,8 años. Tiempo seguimiento en UDP, UDA y global: 10,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5,0, 4,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,6 y 15,0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5,7 años; el 6% perdió el seguimiento médico. En UDA: el 6% desconocía última HbA1c y el 29% las complicaciones crónicas. El control metabólico empeoró en 52% pacientes (aumento HbA1c +0,79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,70%). No encontramos correlación entre el tiempo evolución y la HbA1c. El 96% de los pacientes refirieron grado satisfacción bueno/muy bueno respecto a UDP y el 74% respecto a UDA.</p> <span class="elsevierStyleSectionTitle" id="sect0055">Conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Parece necesaria una mejor planificación de la transición de pacientes con DM1 a las UDA para evitar el empeoramiento del control clínico y/o la pérdida de seguimiento.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín-Frías M, Álvarez MA, Yelmo R, Alonso M, Barrio R. Evaluación de la transición desde la Unidad de Diabetes Pediátrica a la de Adultos en adolescentes con diabetes mellitus tipo 1. An Pediatr (Barc). 2014;81:389–392.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ADU: adult diabetes unit; PDU: paediatric diabetes unit.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HbA1c levels (%) expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Checkups/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">24<span class="elsevierStyleHsp" style=""></span>h access \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Support from educator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Refresher education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">HbA1c (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">HbA1c <7.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ADU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab598064.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Followup characteristics by type of diabetes unit.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes in adolescence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Court" 1 => "F.J. Cameron" 2 => "K. Berg-Kelly" 3 => "P.G. Swift" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-5448.2009.00586.x" "Revista" => array:6 [ "tituloSerie" => "Pediatr Diabetes" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "185" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19754629" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transition to adult care for youths with diabetes mellitus: findings from a universal health care system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Nakhla" 1 => "D. Daneman" 2 => "T. To" 3 => "G. Paradis" 4 => "A. Guttmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2009-0041" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2009" "volumen" => "124" "paginaInicial" => "e1134" "paginaFinal" => "e1141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19933731" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploring a black hole: transition from paediatric to adult care services for youth with diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Pacaud" 1 => "J.F. Yale" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Paediatr Child Health" "fecha" => "2005" "volumen" => "10" "paginaInicial" => "31" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19657443" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of patients’ opinion and metabolic control after transfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.P. Busse" 1 => "P. Hiermann" 2 => "A. Galler" 3 => "M. Stumvoll" 4 => "T. Wiessner" 5 => "W. Kiess" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000096583" "Revista" => array:6 [ "tituloSerie" => "Horm Res" "fecha" => "2007" "volumen" => "67" "paginaInicial" => "132" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17065819" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society)" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Diabetes Association Transitions Working Group" "etal" => false "autores" => array:2 [ 0 => "A. Peters" 1 => "L. Laffel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc11-1723" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2011" "volumen" => "34" "paginaInicial" => "2477" "paginaFinal" => "2485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22025785" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Translating transition: a critical review of the diabetes literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Nakhla" 1 => "D. Daneman" 2 => "M. Frank" 3 => "A. Guttmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Endocrinol Metab" "fecha" => "2008" "volumen" => "21" "paginaInicial" => "507" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18717235" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transition process of patients with type 1 diabetes (T1DM) from paediatric to the adult health care service: a hospital-based approach" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Cadario" 1 => "F. Prodam" 2 => "S. Bellone" 3 => "M. Trada" 4 => "M. Binotti" 5 => "M. Trada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Endocrinol (Oxf)" "fecha" => "2009" "volumen" => "71" "paginaInicial" => "346" "paginaFinal" => "350" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with Type 1 diabetes aged 15–25 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.J. Holmes-Walker" 1 => "A.C. Llewellyn" 2 => "K. Farrell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Diabet Med" "fecha" => "2007" "volumen" => "24" "paginaInicial" => "764" "paginaFinal" => "769" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Supporting the health care transition from adolescence to adulthood in the medical home" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians; Transitions Clinical Report Authoring Group" "etal" => false "autores" => array:2 [ 0 => "W.C. Cooley" 1 => "P.J. Sagerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2011-0969" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2011" "volumen" => "128" "paginaInicial" => "182" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21708806" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Fleming" 1 => "B. Carter" 2 => "W. Gillibrand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Nurs" "fecha" => "2002" "volumen" => "11" "paginaInicial" => "560" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12201882" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving the transition between paediatric and adult healthcare: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Crowley" 1 => "I. Wolfe" 2 => "K. Lock" 3 => "M. McKee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/adc.2010.202473" "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2011" "volumen" => "96" "paginaInicial" => "548" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21388969" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The Diabetes Control and Complications Trial Research Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199309303291401" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1993" "volumen" => "329" "paginaInicial" => "977" "paginaFinal" => "986" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8366922" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Epidemiology of Diabetes Interventions and Complications (EDIC)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "1999" "volumen" => "22" "paginaInicial" => "99" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10333910" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glycemic control in youth with diabetes: The SEARCH for diabetes in Youth Study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "SEARCH for Diabetes in Youth Study Group" "etal" => true "autores" => array:6 [ 0 => "D.B. Petitti" 1 => "G.J. Klingensmith" 2 => "R.A. Bell" 3 => "J.S. Andrews" 4 => "D. Dabelea" 5 => "G. Imperatore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2009.05.025" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2009" "volumen" => "155" "paginaInicial" => "668" "paginaFinal" => "672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19643434" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.S. Bryden" 1 => "R.C. Peveler" 2 => "A. Stein" 3 => "A. Neil" 4 => "R.A. Mayou" 5 => "D.B. Dunger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2001" "volumen" => "24" "paginaInicial" => "1536" "paginaFinal" => "1540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11522695" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health care transition in adolescents and young adults with diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Bowen" 1 => "J. Henske" 2 => "A. Otter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Diabetes" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "99" "paginaFinal" => "106" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "SEARCH for Diabetes in Youth Study Group" "etal" => true "autores" => array:6 [ 0 => "D.S. Lotstein" 1 => "M. Seid" 2 => "G. Klingensmith" 3 => "D. Case" 4 => "J.M. Lawrence" 5 => "C. Pihoker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2012-1450" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2013" "volumen" => "131" "paginaInicial" => "e1062" "paginaFinal" => "e1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23530167" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008100000006/v1_201412100926/S234128791400101X/v1_201412100926/en/main.assets" "Apartado" => array:4 [ "identificador" => "26004" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008100000006/v1_201412100926/S234128791400101X/v1_201412100926/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791400101X?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 13 | 20 |
| 2024 October | 50 | 30 | 80 |
| 2024 September | 43 | 29 | 72 |
| 2024 August | 63 | 55 | 118 |
| 2024 July | 37 | 30 | 67 |
| 2024 June | 43 | 44 | 87 |
| 2024 May | 52 | 26 | 78 |
| 2024 April | 41 | 42 | 83 |
| 2024 March | 31 | 24 | 55 |
| 2024 February | 39 | 25 | 64 |
| 2024 January | 22 | 26 | 48 |
| 2023 December | 27 | 26 | 53 |
| 2023 November | 29 | 23 | 52 |
| 2023 October | 29 | 22 | 51 |
| 2023 September | 25 | 25 | 50 |
| 2023 August | 35 | 15 | 50 |
| 2023 July | 32 | 22 | 54 |
| 2023 June | 28 | 26 | 54 |
| 2023 May | 36 | 22 | 58 |
| 2023 April | 25 | 10 | 35 |
| 2023 March | 40 | 27 | 67 |
| 2023 February | 34 | 19 | 53 |
| 2023 January | 21 | 19 | 40 |
| 2022 December | 42 | 35 | 77 |
| 2022 November | 45 | 58 | 103 |
| 2022 October | 66 | 42 | 108 |
| 2022 September | 22 | 47 | 69 |
| 2022 August | 39 | 42 | 81 |
| 2022 July | 25 | 38 | 63 |
| 2022 June | 19 | 24 | 43 |
| 2022 May | 28 | 44 | 72 |
| 2022 April | 31 | 41 | 72 |
| 2022 March | 38 | 41 | 79 |
| 2022 February | 24 | 26 | 50 |
| 2022 January | 29 | 44 | 73 |
| 2021 December | 23 | 34 | 57 |
| 2021 November | 28 | 42 | 70 |
| 2021 October | 45 | 59 | 104 |
| 2021 September | 21 | 24 | 45 |
| 2021 August | 43 | 47 | 90 |
| 2021 July | 24 | 22 | 46 |
| 2021 June | 25 | 31 | 56 |
| 2021 May | 35 | 44 | 79 |
| 2021 April | 41 | 71 | 112 |
| 2021 March | 56 | 17 | 73 |
| 2021 February | 35 | 8 | 43 |
| 2021 January | 26 | 9 | 35 |
| 2020 December | 41 | 18 | 59 |
| 2020 November | 29 | 22 | 51 |
| 2020 October | 23 | 16 | 39 |
| 2020 September | 17 | 12 | 29 |
| 2020 August | 23 | 9 | 32 |
| 2020 July | 23 | 16 | 39 |
| 2020 June | 18 | 6 | 24 |
| 2020 May | 32 | 15 | 47 |
| 2020 April | 32 | 18 | 50 |
| 2020 March | 27 | 16 | 43 |
| 2020 February | 41 | 13 | 54 |
| 2020 January | 29 | 20 | 49 |
| 2019 December | 48 | 13 | 61 |
| 2019 November | 35 | 10 | 45 |
| 2019 October | 30 | 14 | 44 |
| 2019 September | 41 | 9 | 50 |
| 2019 August | 45 | 17 | 62 |
| 2019 July | 34 | 15 | 49 |
| 2019 June | 36 | 20 | 56 |
| 2019 May | 35 | 15 | 50 |
| 2019 April | 35 | 18 | 53 |
| 2019 March | 33 | 16 | 49 |
| 2019 February | 39 | 14 | 53 |
| 2019 January | 40 | 24 | 64 |
| 2018 December | 39 | 19 | 58 |
| 2018 November | 62 | 22 | 84 |
| 2018 October | 78 | 12 | 90 |
| 2018 September | 35 | 15 | 50 |
| 2018 August | 2 | 0 | 2 |
| 2018 July | 4 | 0 | 4 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 9 | 0 | 9 |
| 2018 April | 26 | 0 | 26 |
| 2018 March | 38 | 0 | 38 |
| 2018 February | 14 | 0 | 14 |
| 2018 January | 24 | 0 | 24 |
| 2017 December | 14 | 0 | 14 |
| 2017 November | 16 | 0 | 16 |
| 2017 October | 12 | 0 | 12 |
| 2017 September | 12 | 0 | 12 |
| 2017 August | 13 | 0 | 13 |
| 2017 July | 25 | 0 | 25 |
| 2017 June | 30 | 8 | 38 |
| 2017 May | 32 | 8 | 40 |
| 2017 April | 56 | 44 | 100 |
| 2017 March | 16 | 3 | 19 |
| 2017 February | 14 | 2 | 16 |
| 2017 January | 19 | 4 | 23 |
| 2016 December | 18 | 4 | 22 |
| 2016 November | 24 | 9 | 33 |
| 2016 October | 40 | 7 | 47 |
| 2016 September | 25 | 4 | 29 |
| 2016 August | 19 | 1 | 20 |
| 2016 July | 9 | 0 | 9 |
Show all
