In a recent review of the medical literature on transitioning from a pediatric to adult healthcare provider, UF Health diabetes experts found that substantially more must be done to help established diabetes patients navigate their way.
While youth incidences of type 1 (T1D) and type 2 diabetes (T2DM) are increasing, the focus on having a transition plan from pediatric to adult care is not– and could imply poorer health outcomes and increased medical costs over the long-term.
The new findings were released in the Feb. 2014 edition the journal Endocrine Today, citing “a remarkably flawed transition process” where there is insufficient planning, discussing, and preparing pediatric patients for the transition and help them feel ready to navigate through the complex adult health care system. Both an overview and key obstacles of this process are discussed. For both patients and clinicians, major challenges include:
- parental anxiety as their ‘children’ become adults
- gaps in health insurance during this transition period
- unique post-high school challenges, such as self-responsibility and readiness
- limited experience of adult providers working with childhood-onset conditions
- building new relationships that take considerable time and effort to reestablish with adult providers
The different forms of the disease can make long-term management from childhood to adulthood difficult. “For example, patients diagnosed with T1D have a very different set of transition issues than T2DM patients,” says Dr. Desmond Schatz, M.D., medical director for the UF Diabetes Institute. Furthermore, insulin and metformin are approved for use in children, while an array of medications can be prescribed in an adult healthcare setting.
Authors call for increased collaboration among pediatric and adult providers and more investigations that will add to the knowledge about unique challenges in transitioning. Also listed are 14 concrete steps offered up by the American Diabetes Association –including involving an adult care provider prior to transition, and planning out at least 1 year in advance– to increase the likelihood of a positive transition experience.
Turner JR, Schatz DA, Cusi K, Strumph P. Healthcare Transition from Pediatric to Adult Medical Homes in Diabetes Mellitus. Endocr Pract. 2014 Jan 21:1-25.