The process of transition from pediatric to adult diabetes care: recommendations for US healthcare systems

Wagner, David V.; Ulrich, Jenae; Guttmann‐Bauman, Ines; Duke, Danny C.

doi:10.2217/dmt.15.31

Cited by 6 publications

(8 citation statements)

References 58 publications

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“…22 In addition, roughly two-thirds (65%) of transition-age youth indicate they have experienced at least 1 unfavorable medical outcome due to suboptimal access to medical care. 28 In particular, lack of access to mental health professionals for transition-age youth with psychologicalcomorbidities is often cited as a major barrier to care in this age group. 4 Thus, the process of improving outcomes for transition-age youth should focus on both improving metabolic control and on timely identification and treatment of psychological comorbidities.…”

Section: What Is Transition Of Care and Why Is It Important?mentioning

confidence: 99%

“…22 In addition, roughly two-thirds (65%) of transition-age youth indicate they have experienced at least 1 unfavorable medical outcome due to suboptimal access to medical care. 28…”

Section: Current State Of Glycemic Control In Transition-age Populatimentioning

confidence: 99%

“…Even though they belong to a tech-savvy generation, the utilization of health care related technology in this group is lower than any other group. Barriers to successful technology integration into the transition process are likely falling into similar categories as the barriers to successful transition itself: 28 patient-, family-, health-care-provider-, and health-care-system-related barriers. It is our opinion that majority of those barriers could be addressed by targeted use of technology, as postulated in Table 1.…”

Section: The Promise Of Technology: Where Do We Go From Here?mentioning

confidence: 99%

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Technology Use in Transition-Age Patients With Type 1 Diabetes

Los

Ulrich

Guttmann‐Bauman

2016

J Diabetes Sci Technol

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Youth with chronic illnesses have the greatest risk for a decline in their health management during transition-age. Because of this demonstrated and well-known issue, research has focused on how to improve the transition of care process. Despite the increasing number of technological devices on the market and the advances in telemedicine modalities available to patients with type 1 diabetes (T1D), the utilization of technology is still suboptimal among patients of transition-age (ages 13-25). This article reviews the available resources, patterns of use in transition-age youth, and explores opportunities to advance technology use in transitioning patients with T1D from pediatric to adult care.

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Section: What Is Transition Of Care and Why Is It Important?mentioning

confidence: 99%

“…22 In addition, roughly two-thirds (65%) of transition-age youth indicate they have experienced at least 1 unfavorable medical outcome due to suboptimal access to medical care. 28…”

Section: Current State Of Glycemic Control In Transition-age Populatimentioning

confidence: 99%

Section: The Promise Of Technology: Where Do We Go From Here?mentioning

confidence: 99%

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Technology Use in Transition-Age Patients With Type 1 Diabetes

Los

Ulrich

Guttmann‐Bauman

2016

J Diabetes Sci Technol

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“…Such programs should include education for paediatric care providers, pre-pregnancy programs for women [ 8 ], and screening for mental health co-morbidities [ 3 ], thus optimising transition of care from paediatric to adult clinic. The transition conversations should happen early with the care appropriately tailored to the developmental level and unique needs of emerging adults [ 9 ]. These strategies may improve glycaemia, reduce the frequency of diabetic ketoacidosis (DKA)-related hospitalisations, and improve clinic attendance [ 4 , 10 ], thereby reducing short term personal and financial burden [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic

Sritharan

Osuagwu

Ratnaweera

et al. 2021

IJERPH

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The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions.

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“…Such programs should include education for paediatric care providers, pre-pregnancy programs for women [8], and screening for mental health co-morbidities [3], thus optimising transition of care from paediatric to adult clinic. The transition conversations should happen early with the care appropriately tailored to the developmental level and unique needs of emerging adults [9]. These strategies may improve glycaemia, reduce the frequency of diabetic ketoacidosis (DKA)-related hospitalisations, and improve clinic attendance [4,10], thereby reducing short term personal and financial burden [11].…”

Section: Introductionmentioning

confidence: 99%

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic

Sritharan¹,

Osuagwu²,

Ratnaweera³

et al. 2021

Preprint

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The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective review of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012-2016) and after (2017-2018) restructuring of a clinic for young adults aged 16-25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n=184, 83.2%), 40.5% (n=89) had a mental health condition particularly, depression (n=57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs 0.8% p=0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher HbA1c at the last visit (9.4%[79 mmol/mol] vs 8.7% [71 mmol/mol], p=0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs 42.7%,p=0.009), smoking (38.4 vs 13.6%,p=0.009), retinopathy (9.0 vs 2.3%,p=0.025), multiple DKAs (28.4 vs 16.0%,p=0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% Confidence intervals 1.1-3.7) fold increased risk of HbA1c ≥ 9.0%[75mmol/mol]. Changes to the clinic were not associated with improvements in mental health condition (39.0% vs 32.4%, p=0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies are required to reduce complication risks among those with mental health conditions. .

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The process of transition from pediatric to adult diabetes care: recommendations for US healthcare systems

Cited by 6 publications

References 58 publications

Technology Use in Transition-Age Patients With Type 1 Diabetes

Technology Use in Transition-Age Patients With Type 1 Diabetes

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic

Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic

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