Follow-up of Adolescents with Diabetes after Transition from Paediatric to Adult Care: Results of a 10-year Prospective Study

Abstract

Transition marks a critical phase for young, diabetic patients as they may frequently switch from one physician or centre to another. The individual optimization of therapy, established during paediatric care, provides the decisive groundwork for disease control in young adults.

A Systematic Review of Transitional Care for Emerging Adults with Diabetes

“…The majority of providers (90%) are in agreement that transition planning should begin at least one year prior to transition (de Beaufort, et al, 2010). Reasons for transition to adult care are topped by the patient's wish to transition followed by suggestion to transition given by the treating pediatric provider (Neu et al, 2010). …”

“…The majority of emerging adults feel prepared for the transition from pediatric to adult diabetes care (Garvey et al, 2013; Neu, et al, 2010). Emerging adults know they will age out of pediatric care, and transition is accepted as an inevitable and a natural process (Begley, 2013; Ritholz, et al, 2014); however, 34% of emerging adults still report a gap of longer than six months between pediatric and adult diabetes care (Garvey et al, 2012).…”

“…The visit time in the adult clinic was short (≤5 minutes), and the doctor was not knowledgeable on emerging adults’ past glycemic control history and challenges (Kime, 2013; Lundin, et al, 2008). Within the first two years of adult care, 17% of patients have changed adult providers (Neu, et al, 2010). …”

Transition to adult endocrine services: What is achievable? The diabetes perspective

“…Ascertainment bias is contributory, particularly for self-reported follow up studies; there is likely to be a self-selection bias of those individuals who respond to such studies and in the absence of prospective longitudinal follow up using population-based registries, follow up data is likely to be inaccurate. Apparent losses to follow will also include those who have changed provider multiple times before stable adult follow up is established, a well-recognised phenomenon [6,16,23]. Nonetheless, the fact that up to one third of young adults with T1DM are reported to have disengaged from specialist services is of concern, indicating that measures to improve transition processes and follow up are urgently required.…”

“…The frequency of hospital clinic attendance has been found to decrease after transition [23,26,27], often with prolonged gaps in medical care between paediatric and adult review [16, 28,29]. Those most at risk of diminishing medical input over the transition process appear to be identifiable pre-transition with risk factors which include low rates of paediatric clinic attendance, higher HbA1c at transition, a history of mental health and older age at transition [22,26,30,31].…”