57-LB: The 4 I’s of Adolescent Transition in Type 1 Diabetes Care: A Qualitative Study

Introduction: Adolescents with type 1 diabetes have worsening glycemic control as they transition from pediatric to adult care. The most effective clinical interventions for this population remain elusive. The aim of this study was to gain adolescent perspectives on the transition preparation experience and the preferred approaches to the transition process in type 1 diabetes care. Methods: We conducted 5 focus groups with a total of 22 adolescents with type 1 diabetes. Participants also completed an embedded survey where they rated various transition interventions. Transcriptions of audio recordings were analyzed with 3 iterations of thematic content analysis using the grounded theory approach and we determined that saturation was reached. Results: Four themes related to transition of care were identified: (1) Identity - how the world relates to my diabetes (stigma of type 1 diabetes, confusion with type 2 diabetes, diagnosis disclosure, and resilience); (2) Interconnection - how my support system can help me with my diabetes (peer support, near peer support, parental support, loss of bond with pediatric team, and fear of not having a bond with adult team); (3) Impediment - how my diabetes limits me (self-care takes work and time, unpredictability and restrictiveness, and emotional burden); and (4) Individualization - how to personalize the transition experience (having choices in the transition experience, meeting adult provider before transition, and specific transition preparation). The top interventions rated by adolescents on the survey were: good communication between the pediatric and adult teams, medical summary of past diabetes care, and having pediatric and adult teams in the same building. Conclusions: The design of future transition interventions for adolescents with type 1 diabetes should address the issues of Identity, Interconnection, Impediment, and Individualization. Adolescents also identified collaborative processes between pediatric and adult providers as most important. Disclosure J.M. Leung: Research Support; Self; Lilly Diabetes. T.S. Tang: None. C. Lim: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. S. Amed: None. Funding Eli Lilly and Company