Transition from pediatric to adult diabetes care: smooth or slippery?

Abstract

de Beaufort C, Jarosz‐Chobot P, Frank M, Frank M, de Bart J, Deja G. Transition from pediatric to adult diabetes care: smooth or slippery? Objectives: The purpose of this study is to evaluate the practices of diabetes health care providers concerning the transition from pediatric to adult diabetes care. The information presented here may help increase awareness of the organization of transitional care for young people with diabetes and prevent the loss of follow‐up during this vulnerable period in their lives. Methods: A questionnaire with an explanatory letter was sent to all members (n = 578) of the International Society for Pediatric and Adolescent Diabetes (ISPAD). A follow‐up mailing was sent 4 months later. Results: In total, 92 questionnaires (16%) from members representing 36 countries were included in the analysis. In 76% of the centers, youth are seen until the age of 18 yr; 36% of the pediatric centers see adults > 25 yr; 30% report children under the age of 16 receive follow up from adult diabetologists or internists. About half of the programs already have a structured transition process usually targeting youth 16–25 yr of age. The majority of responders propose that preparation for transition starts at least 1 yr prior to leaving the pediatric center. Conclusion: Youth with type 1 diabetes often struggle to keep diabetes management a priority and find it challenging to maintain optimal metabolic control. When they graduate from pediatric care, some of these young people opt out of care altogether, only to resurface in the medical system when they develop complications which may have been prevented. Our survey of diabetes health care professionals in 36 countries worldwide shows that the actual transition practices in many places are far from optimal and require improvement. Transitional care should start early and strategies should promote uninterrupted, comprehensive, and accessible adult care.

Improving the transition from pediatric to adult diabetes care: the pediatric care provider's perspective in Quebec, Canada

“…15 A 2007 survey of pediatric diabetes centers in 36 countries found that most centers did not have a structured transition care program. 16 This suggests important deficiencies in transition care, but inferences are limited by a low 16% response rate. 16 We were able to conduct in-depth interviews with key respondents at 12 of 15 pediatric diabetes centers in Quebec in the present study, permitting us to address important knowledge gaps in pediatric care providers' perspectives on transition care.…”

Avoidable Hospitalizations in Youth With Kidney Failure After Transfer to or With Only Adult Care

“…4,5 Transfer to adult-oriented health services occurs in late adolescence (around age 18 years) and may exacerbate these high-risk behaviors. 6 These periods of nonadherence to medications, clinic appointments, and routine blood work may lead to detrimental and sometimes irreversible outcomes. [7][8][9] Therefore, adolescence and emerging adulthood in general, as well as the time after transfer of care in particular, are critical periods.…”

A Systematic Review of Transitional Care for Emerging Adults with Diabetes

“…Transition from pediatric to adult health care for adolescents with type 1 diabetes is suggested to occur between the ages of 14 to 25 (de Beaufort, Jarosz-Chobot, Frank, de Bart, & Deja, 2010). Median age of transition is 20.1 years (Lotstein et al, 2013).…”

“…Median age of transition is 20.1 years (Lotstein et al, 2013). 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).…”