From Pediatric To Adult Diabetes Care: Transition Improvement Studied

A survey at Boston Children’s Hospital showed the transition from pediatric to adult healthcare services, for those with type 1 diabetes, could use some improving.

Questions about the transition experience were given to two groups of young adults with type 1 diabetes. Out of 602 patients surveyed, just over half were still in pediatric care; the others had already entered adult services.

The survey revealed current guidelines for transition preparation and coordination of care could be implemented more effectively. “We need to develop systems to help providers provide efficient, standardized transition preparation education and counseling for youth with diabetes,” said Dr. Katherine Garvey of Boston Children’s Hospital.

In the pediatrician group, survey answers showed the average age of transition to adult services was 22. Two-thirds of the respondents said this was owed to an emotional attachment they had formed with their pediatric providers.

While over 80 percent of the pediatrician group reported discussions with providers about general diabetes management, only 60 percent had conversations about prescriptions and appointment setting; 55 percent had gone over the transition process or had a completed plan. Fewer than one-fifth of this group received something in writing regarding their transition.

Of the surveyed patients already in adult care, the average age of transition was 19. Most of them, 63 percent, had switched to an adult healthcare team after their pediatrician received a specific referral. Sixty-six percent of those referred reported feeling ready for the change, and these patients had fewer subsequent diabetes-related problems.

The Boston survey findings were published in the journal Diabetes Care, where the authors note that patient and parental attachment to pediatricians had earlier been identified as a transition barrier in young patients with chronic conditions, including type 1 diabetes. They recommend this issue be addressed during patient counseling.

For a more efficient transition, the investigators advocate for improved self-management counseling, the creation of a written transition plan, and that specific referrals to an adult provider are issued.

“Prioritizing transition preparation and planning may increase young adult engagement in care across the transition, and help protect them from gaps in care and adverse outcomes,” said Garvey.

Source: Diabetes UK