From Youth to Adulthood: Transitioning the Care of Patients with Diabetes

With the prevalence of diabetes increasing among children and adolescents, more emphasis is needed on helping these individuals transition from pediatric health care—in which treatment is supervised—to adult care, in which they are responsible for managing their own health, according to a new American Diabetes Association position statement.

A number of challenges emerge during the transition period that need to be addressed, including gaps in health insurance, fundamental differences in the way care is delivered to children and adults, critical developmental issues in specific age groups, loss of follow-up care, the emergence of chronic complications, and a lack of research regarding approaches for treating emerging young adults (aged 18 to 30 years).

This first-ever position statement on this topic in diabetes, which is published in the November issue of Diabetes Care, recommends the following:

• Pediatric health care providers begin preparing adolescents at least 1 year prior to the transition;
• That there be a gradual shift to self-management (such as glucose self-monitoring and insulin delivery, along with scheduling appointments and monitoring supplies);
• That pediatric providers supply transitioning patients with written summaries of care issues and medication lists;
• That referrals be made to adult providers with experience in intensive management;
• That special attention be paid to screening for complications, disordered eating behaviors and mental health issues at this time;
• That an open discussion of birth control, drug and alcohol use, smoking and sexually transmitted diseases be held, in particular addressing the interplay between these behaviors and living with diabetes.

Each year, tens of thousands of emerging young adults with type 1 or type 2 diabetes are estimated to be transitioning from pediatric to adult health care.

“This is a period of life that is really critical for ensuring continuity of care, given how many changes in lifestyle young adults are going through as they enter college, move out of their parents’ household or begin supporting themselves,” said Anne Peters, MD, CDE, co-chair of the American Diabetes Association’s Transitions Working Group, and Professor, Keck School of Medicine of USC, in a statement. “But until now, it has not received the attention it deserves. We are concerned that with such large numbers of young people developing diabetes in recent years, failure to address their special treatment concerns could lead to a major public health problem.”

The SEARCH for Diabetes in Youth study has estimated that approximately 15,000 youth are diagnosed annually with type 1 diabetes and about 3700 are diagnosed annually with type 2 diabetes. In 2001, SEARCH estimated that there were approximately 154,000 youth aged 20 years and younger with diabetes; in 2010, the estimated number of youth with diabetes had climbed to 215,000.

“The statement emphasizes the special but changing role that the family must play during the transitional period as well,” said Lori Laffel, MD, MPH, the Transitions Working Group’s other co-chair.

According to Dr. Laffel, the ADA statement—which was developed by a multidisciplinary group of experts that included physicians, nurses, and patients—aims to address the “need for more research to help improve care and outcomes for emerging young adults during their transitions from pediatric to adult diabetes care.”

Worldwide, the prevalence of type 1 diabetes in children and young adults has doubled in the past 25 years and is expected to double again in the next 15-20 years. The SEARCH for Diabetes in Youth study showed that only 32% of youth with type 1 diabetes aged 13 to 18 years and 18% of those aged 19 years and older achieved ADA-recommended A1C targets.

To access the position statement, click here.