A Canadian study has found that there are huge gaps in care for patients with diabetes transitioning from adolescent to adult care, and that pediatricians should offer more education to make the process go smoother.
The study, published in BMJ Open Diabetes Research and Care, investigated the transition process during the high-risk period of adolescence to adulthood. This transition is often marked by inadequate medical follow-up, poor self-management, and an increased risk of adverse events.
The period between ages 18 to 25 years can be a trying time, according to the research team, because patients are in a vulnerable stage wherein autonomy and self-identity are still developing. Patients with diabetes have added stress because of the daily demands of their disease and the necessary transition from care managed in a pediatric setting to an adult setting, the report notes.
“The transition to adult care occurs at a point in life concurrent with numerous physiological and psychosocial changes, including a deterioration in glycemic control, decreased adherence to self-management tasks, and to clinic attendance, as well as an increased risk of adverse outcomes,” the researchers note, adding that patients often feel abandoned or uneasy during this transition process. This may result in increased risk, particularly when it comes to compliance with new regimens and provider recommendations.
The study references data presented in the SEARCH for Diabetes in Youth Study that found young adults were nearly 3 times more likely to have poor glycemic control during this transition period than those who remain in pediatric care. Careful planning is required to avoid negative outcomes during the transition process, with the ultimate goal being to provide coordinated and uninterrupted care that meets the patient’s developmental abilities.
The American Diabetes Association has drafted recommendations for this transition period, and other pediatric groups have jointly issued similar guidelines. The basis of these recommendations include creating a transition policy; assembling a transitioning youth registry; offering transition readiness and planning; having a plan for transfer of care; and taking steps to ensure transitions have been completed.
The researchers note that fewer than 15% of young adults receive written transition care, or even have a specific dialogue about transitioning to adult care with their pediatric provider. In fact, the study notes that few diabetes centers have structured transition programs.
For the report, researchers interviewed healthcare providers at 12 diabetic care centers about transition strategies and structures, as well as patient perceptions about the transition process and barriers to care.
Three of the centers (25%) reported having formal and structured transition plans in place, according to the report, and physicians within those centers perceived a smoother transition and better information sharing when referrals were made from pediatric providers from within the same center. Discussions about transitioning to adult care typically begin when the patient is aged around 12 to 14 years, but researchers also noted that most facilities created transition plans without involvement from patients or their families. Few facilities had special programs for patients with developmental or intellectual deficits.
Seven of the centers investigated had uniform transition policies based on patient age (often at 18 years), and the remainder offered flexible transition times based on the preference of the patient. Four of the facilities continued care for an extended period because of the use of insulin pump therapy and a perception that adult care centers may be unwilling to provide care to those patients. Just 1 center had a registry for transitioning young adults to aid in the process.