Transitioning Teens from Pediatric Health Systems: Pediatric Endocrinologists Talk Diabetes

It's not easy to be a teen with diabetes. Many young adults struggle with competing academic, economic, and social priorities that may interfere with successful diabetes management. Coordinated healthcare can lessen the risk of suboptimal health care utilization; undetected or untreated diabetes complications; and psychosocial, behavioral, and emotional challenges.

It's not easy to be a teen with diabetes. Young adults don't often think about risk factors for complications (hypertension, hyperlipidemia) and high-risk behaviors (cigarette smoking, alcohol/drug abuse). Many young adults struggle with competing academic, economic, and social priorities that may interfere with successful diabetes management.

Coordinated healthcare can lessen the risk of suboptimal health care utilization; undetected or untreated diabetes complications; and psychosocial, behavioral, and emotional challenges. In 2011, the American Diabetes Association (ADA) published recommendations for pediatric providers transitioning young adults with T1DM (Type 1 Diabetes Mellitus) into adult care.

Despite the ADA consensus statement, transitioning young adults receive inconsistent care and few studies have examined associated barriers. Now, a new study published in the International Society for Pediatric and Adolescent Diabetes (ISPAD) describes the results from a 22-question national survey of pediatric endocrinologists to find answers.

Survey respondents considered patient/family request for transfer, pregnancy, glycemic control, entering college, and a new diagnosis of a diabetes-related complication or comorbidity as reasons to initiate transfer.

When respondents transferred care from pediatric to adult providers, 55% of survey respondents acknowledged sending medical records with the patient, but 20% admitted they had not communicated with the receiving practitioner. Among those who communicated, 15% used a clinical summery letter, 7% had a phone conversation, and 3% actually used a transition template summary.

The most common barriers to transitioning care were ending a long-term therapeutic relationship with the patient, lack of transition protocols, and perceived deficiencies in adult care.

Do clinicians need focused training on transition care to overcome local health systems and perceived barriers? These researchers suggest the need for actionable solutions to bridge transitions better. These would include joint discussion between the patient/family and adult provider prior to transfer; a referral algorithm; transition readiness assessment tools; transition materials for patients; and transition-specific visits. A majority of survey respondents favored these solutions.

The researchers report a low survey response of just 16% consisting primarily of pediatric endocrinologists. This group of survey respondents may not be representative of all care providers for young adults with T1DM.

Endocrinologists need to work with their staffs to design programs that identify a transition method that leads to timely follow-up visits. They also need to evaluate the programs periodically.

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