Suggestions in improving the transition from pediatric to adult care in patients with type 1 diabetes

Young adulthood can be a trying time for any person, but for people with type 1 diabetes, these years pose even more difficulties. They have the same challenges as a typical teen with trying to figure out the next steps in their education and life plans, but they need to do this while managing their diabetes and attending medical visits.

During this tumultuous time, patients often worry about leaving behind their pediatric endocrinology support systems. Most patients transition to adult care between the ages of 18 to 21. This is a critical time period when these patients are at a high risk of poor glycemic control, which can result in long-term complications. These teens need to be supported carefully during this time period by both their pediatric endocrinologists and their new adult endocrinologists.

In our recent review, we focus on the challenges during the transition period and provide recommendations on how to navigate this process which can be stressful for the teen, the family, and the pediatric and adult endocrinologists.

The adult endocrinologist must also focus on establishing a relationship and not just on perfecting the patient’s blood glucose levels.

Determining when to transition is an important step for the pediatric endocrinologist, which should be established by an evaluation of the teen’s readiness, understanding of medications and diet, and knowledge of managing emergencies. The pediatric endocrinologist can then make objective assessments of knowledge and skill levels based on this information.

If a teen has particular strengths or gaps in knowledge, this information should be conveyed to the adult endocrinology team so they can capitalize on the strengths and identify any need for intervention. This is a chance for the teen to “start over” which should be framed in a nonthreatening pragmatic manner.  This should be viewed as an opportunity to establish a new, mature relationship with both the teen’s and physician’s goals clearly stated.

The adult endocrinologist must also focus on establishing a relationship and not just on perfecting the patient’s blood glucose levels. These teens and their families have grown up with their pediatric endocrinologist who likely accompanied them in weathering the angst of adolescence that may still be on-going. The late-teen or young adult craves the same type of relationship with their adult endocrinologist.

While glycemic control in this age group is poor, studies show that new providers of satisfied patients earned their patient’s confidence by listening carefully and involving them in management decisions. Once the relationship is solidified, the next step would then be to improve glycemic control.

Young adults have many stressors and psychological burdens even without a chronic medical condition. Depression is nearly twice as common in patients with diabetes compared to patients without diabetes with significantly higher rates of anxiety, eating disorders, and diabetes distress. Given the numerous demands facing this population, it is necessary for adult providers to develop a strategy to routinely identify and address psychosocial needs for young adult patients. Studies show that support groups in this age group significantly reduce diabetes related distress.

A team-based approach is the best way to help the young adults stay engaged.  In our opinion, diabetes care is best provided by a multidisciplinary team which includes physicians, nurses, dietitians, social workers and psychologists. Each member contributes in a way tailored to the young patient’s individual needs and goals. By developing an appropriate transition from pediatric to adult care, we believe that patients can be successful in achieving appropriate glycemic control, avoid long term diabetes complications, reduce distress and be content in their new medical home.