More responsibility and new providers complicate TID management for teens

There are a lot of challenges in the transition from youth to adulthood. For children and teens with chronic diseases like type 1 diabetes, these challenges—and the consequences they bring—only increase.

Compliance with type 1 diabetes management is tricky at any age, but young adults in the transition from childhood to adulthood tend to see the highest rates of missed insulin doses and hospitalizations from complications of their disease.

A study published in the Scandinavian Journal of Caring Sciences delves into this phenomenon and examines how the relationship between provider and patient—particularly during this period of transition—can impact diabetes management.

Work and school schedules, as well as personal habits and relationships, make diabetes management especially challenging for teens and young adults, according to the report. There is also the added challenge of transitions in care during this time, researchers note.

For many young adults, the teen years is a time to transition from a pediatric provider to a provider more focused on primary young adult or adult care. This transition, however, can disrupt the continuity of care for these patients, especially as they work to establish trust and a relationship with a new provider.

The study team examined the specific experiences of 15 teens transitioning from pediatric to youth clinic care for their type 1 diabetes and questioned them about the experience.

One of the main themes in the patients interviewed was the challenge of getting to know a new provider. Teens who had built a strong relationship with their previous provider reported difficulty in adjusting to a new provider who didn’t know as much about them and their personal health. There was also some difficulty in adjusting to a more adult-focused management style in the youth and adult clinics, with some patient reporting their new providers seemed “grumpy and hard.”

This perception could also be attributed to efforts during this transition period to get young adults to assume more responsibility for their own diabetes management. Taking on more accountability for checking and treating their blood glucose levels can be difficult, and the study notes that a strong provider-patient relationship plays an important role in helping young adults adjust to the extra responsibility.

Overall, the report reveals that it’s not just the increased responsibility, but in fact the emotional and psychological challenges of adjusting to a new provider that can make diabetes management in the teen years more difficult.

Continuity of care and a strong relationship with the provider are associated with better outcomes in this population, and this is something providers should address with patients and their families during this transition period, the study authors suggest.

The importance of time and the strength of the provider-patient relationship can be underestimated but has a big impact on patient outcomes and confidence during this time of transition. Practical advice, continuity of support, and a relationship that stems beyond just questions about their diabetes care are all things providers can offer teens to help in this regard, the study concludes.

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Reference:

Laursen MG, Rahbæk MØ, Jensen SD, Prætorius T. Experiences of young people living with type 1 diabetes in transition to adulthood: The importance of care provider familiarity and support. Scand J Caring Sci. 2023;00:1–10. https://doi.org/10.1111/scs.13214.