Young adults with type 1 diabetes (T1D) are at risk for poor glycemic control and adverse diabetes-related health outcomes. There is broad consensus that the lack of coordinated transition from pediatric to adult diabetes care contributes to this risk. A high-quality transition from pediatric to adult diabetes care - encompassing both self-management and uninterrupted follow-up - is an imperative goal. Katharine Garvey, M.D., M.P.H., a pediatric endocrinologist and early health services researcher, will target this understudied area in her Mentored Patient-Oriented Research Career Development Award. Dr. Garvey is uniquely positioned to use this award to launch an independently-funded research career. She completed a fellowship in health services research, through which she gained experience in epidemiology, biostatistics and study design, and she has conducted several preliminary studies in T1D health care transition. Through her proposed career development, she now seeks to gain skills in advanced data analysis (including claims data, longitudinal data, and qualitative data analysis) as well as health intervention design, implementation and evaluation. To achieve these objectives, Dr. Garvey has assembled a multi-disciplinary mentorship team led by national experts in pediatric diabetes outcomes research, general health services research and implementation science, qualitative research, and health care transition.
In Aim 1, Dr. Garvey will use data from a national health insurance plan with an annual enrollment of >30 million individuals to examine patterns of care utilization, diabetes monitoring practices, and clinical outcomes in a diverse national sample of 15-<25 year-old T1D patients.
In Aim 2, she will use qualitative methods to understand the expectations and priorities of older teens with T1D, their parents, and young adults with T1D. Incorporating focus group findings along with knowledge gleaned from the national sample studied in Aim 1, Dr. Garvey will develop a structured group medical visit curriculum to enhance T1D self-management and transition preparation.
In Aim 3, she will implement this curriculum and assess the feasibility of the group medical visit intervention and impact on diabetes self-care and transition readiness. Dr. Garvey's K23 research will form the basis for a fully powered T1D transition intervention study, to be proposed in an R01 application at the end of the K23 period. Dr. Garvey seeks to become an independent researcher with expertise in health outcomes and health care delivery research in youth with T1D, with the long-term objective of investigating how interventions during adolescence can lead to sustained improvements in self-management and health outcomes in young adulthood. Through the proposed career development award, she will acquire important skills in quantitative and qualitative methods and intervention research to ensure achievement of these goals.

Public Health Relevance

Adolescents and young adults with type 1 diabetes must ultimately transition their health care to adult-centered health systems, and the lack of well-planned transitions from pediatric to adult diabetes care may contribute to interruptions in care and poor diabetes-related health outcomes. The goals of this project are to understand patterns of health care utilization for young adults with type 1 diabetes and to develop, implement, and evaluate a group medical visit curriculum to engage youth with type 1 diabetes in self-care and prepare them for transition. This research will advance methods to measure type 1 diabetes transition outcomes and provide information about the feasibility and impact of a group medical visit model for transition preparation.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Hyde, James F
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Children's Hospital Boston
United States
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Sawicki, Gregory S; Garvey, Katharine C; Toomey, Sara L et al. (2017) Preparation for Transition to Adult Care Among Medicaid-Insured Adolescents. Pediatrics 140:
Garvey, Katharine C; Foster, Nicole C; Agarwal, Shivani et al. (2017) Health Care Transition Preparation and Experiences in a U.S. National Sample of Young Adults With Type 1 Diabetes. Diabetes Care 40:317-324
Garvey, Katharine C; Telo, Gabriela H; Needleman, Joseph S et al. (2016) Health Care Transition in Young Adults With Type 1 Diabetes: Perspectives of Adult Endocrinologists in the U.S. Diabetes Care 39:190-7
Markowitz, Jessica T; Garvey, Katharine C; Laffel, Lori M B (2015) Developmental changes in the roles of patients and families in type 1 diabetes management. Curr Diabetes Rev 11:231-8
Sawicki, Gregory S; Garvey, Katharine C; Toomey, Sara L et al. (2015) Development and Validation of the Adolescent Assessment of Preparation for Transition: A Novel Patient Experience Measure. J Adolesc Health 57:282-7