Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes

Abstract

Aims The goals of the study were to describe the transition of youth with Type 1 diabetes from paediatric to adult healthcare services, examine the link of this transition with self care and glycaemic control, and distinguish youth who received medical treatment from different physicians in terms of demographic and parent relationship variables. Methods Youth with Type 1 diabetes (n = 118) were enrolled in a prospective study that examined the transition from the paediatric to adult healthcare systems and were evaluated during their senior year of high school (time 1) and 1 year later (time 2). Data on self care, glycaemic control and parent relationship were collected. Results The majority of youth saw a paediatric endocrinologist at both assessments (n = 64); others saw an adult care physician at both assessments (n = 26) or transitioned from a paediatric endocrinologist to an adult care physician (n = 19). Nine youth saw no physician between time 1 and time 2. There were group differences in demographic and parent relationship variables and self-care behaviour and glycaemic control related to the transition of care. Youth who remained in the paediatric healthcare system had the best self care and did not experience declines in glycaemic control over time. Conclusions Early transition from the paediatric healthcare system to the adult healthcare system is associated with psychosocial variables and worse glycaemic control. Future research should identify factors that determine optimal timing and strategies to avoid deterioration of care and control during this transition.

Cognitive adaptation theory as a predictor of adjustment to emerging adulthood for youth with and without type 1 diabetes

“…There was some modest evidence that the cognitive adaptation index was linked to better glycemic control. Such a link would be extremely important as emerging adults are at risk for poor glycemic control when they move from the pediatric health care system to the adult health care system (48). …”

Type 1 Diabetes in Young Adulthood

“…A review by Lyons, Becker, and Helgeson suggests that young adults maintain stable or even improved glycemic control after the transfer to adult medical care [45]. However, other studies have demonstrated that premature transition to adult medical care is associated with poorer glycemic control [46] and that youth who remain in pediatric care early in young adulthood demonstrate better glycemic control as compared to young adults who transfer to adult care [47]. These data should be interpreted cautiously, as information about glycemic control in young adulthood may represent a biased sample of patients who present for medical care and have appropriate labs drawn.…”

“…Thus, for young adults, clinic attendance, rather than specific indicators of diabetes control, may represent a critical outcome to track [40, 45]. Young adults at risk for poor glycemic control or low rates of clinic attendance post-transfer to adult medical care may have lower income, live in areas with relatively low physician supply, or have a history of poor glycemic control [12, 46]. Assessing readiness for adult medical care and matching the transfer time with perceived readiness, when possible, may enhance outcomes in adult care.…”

Practical Strategies to Enhance Executive Functioning and Strengthen Diabetes Management Across the Lifespan

“…Many young adults will find themselves responsible for making clinic appointments, refilling prescriptions, and finding and managing insurance on their own, often for the first time in their lives. Errors or omissions in diabetes management may therefore become more likely [55]. With new environments and responsibilities, emerging adults will likely have to continuously re-evaluate their plan for integrating T1D care into everyday activities.…”

“…When faced with a long-term goal, Barkley and Benton [55] recommend people create smaller steps toward the larger goal. For example, if an adult wishes to lower his A1c by 1 %, he can identify small, achievable behavioral steps to reach this goal (e.g., checking his BG one more time a day) and give himself small rewards for each small objective met (e.g., each week he successfully conducts one additional check per day).…”