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Education, planning improvements needed for pediatric diabetes patients transitioning to adult care
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Approximately 55% of adolescent and young adult patients with type 1 diabetes reported reviewing the need to transition or a specific transition plan with their pediatric health care provider, whereas less than 20% reported receiving any written transition materials, according to an analysis of survey data.
In a survey of adolescents and young adults with type 1 diabetes aged 18 to 30 years enrolled in the T1D Exchange Clinic Registry, 21% responders also reported a gap in care of at least 6 months when transitioning from their pediatric to adult provider, which was associated with reports of fewer than three visits to the pediatric provider during the 12 months preceding transition.
“A position statement [from] the American Diabetes Association, in collaboration with a number of professional societies, recommends that pediatric providers of diabetes care prepare patients for transition to adult care at least 1 year before transfer and likely during the early adolescent years,” Katharine Garvey, MD, MPH, attending physician in the division of endocrinology at Children’s Hospital Boston, and colleagues wrote. “However, even reflecting the latest advancements at centers in the T1D Exchange in the years after these consensus statements, this study documents persistent deficiencies in key components of transition preparation as reported by young adults.”
Garvey and colleagues analyzed data from 303 patients still receiving care at a pediatric center, who received surveys focusing on transition preparation activities (mean age, 20 years; 60% women; 87% white), and 299 patients who had already transitioned from pediatric to adult care, who received surveys focusing on transition preparation and the transfer process (mean age, 24 years; 62% women; 89% white). All respondents also completed the Self-Care Inventory and Problem Areas in Diabetes scale.
Among responders who were still in pediatric care, more than 90% reported receiving counseling on managing their own diabetes and screening tests; 71% met with their provider without a parent or guardian in the room. However, less than 50% reported discussing alcohol use, scheduling their own appointments or refilling their own prescriptions, and 43% of patients reported discussing reproductive health with their provider. Most participants in pediatric care reported that they stayed with their pediatric provider because they “felt attached,” according to researchers.
“This attachment has previously been identified as a barrier to transition in patients with type 1 diabetes, as well as more generally in pediatric patients with chronic health conditions and [among] their parents, and is an important area to directly address in patient counseling,” the researchers wrote.
Within the adult cohort that already transitioned, 64% reported three or more visits to their pediatric provider in the 12 months before transition; 66% reported they felt “mostly” or “completely” prepared for transition.
However, 63% of patients reported a gap in care of at least 6 months when transitioning; the gap was associated with reports of fewer than three visits to the pediatric provider during the 12 months prior to transition (OR = 3.2; 95% CI, 1.7-6.1) after adjustment for race, insurance status and major life events.
Participants who reported feeling less prepared were also more likely to report a gap in care, according to the researchers. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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