(Reuters Health) -
A survey of young patients with type 1 diabetes shows that the process of transitioning away from care by pediatricians could be improved.
“We still have some work to do in implementing the current practice guidelines regarding transition preparation and care coordination,” Dr. Katherine Garvey of Boston Children's Hospital told Reuters Health by email. “We need to develop systems to help providers provide efficient, standardized transition preparation education and counseling for youth with diabetes.”
Dr. Garvey and her colleagues evaluated transition experiences via electronic survey in two groups of young adults with type 1 diabetes - 303 who were still receiving pediatric care and 299 who had already transitioned to adult care.
In the group still being cared for by pediatricians, the average anticipated age at transition to adult care was 22 years. Two thirds of this group were still in pediatric care because of emotional attachment to their provider.
“This attachment has previously been identified as a barrier to transition in patients with type 1 diabetes as well as more generally in pediatric patients with chronic health conditions and their parents and is an important area to directly address in patient counseling,” the authors note in their report in Diabetes Care.
More than 80 percent of respondents in the pediatric care group had discussed general diabetes self-management with their providers; 60 percent had discussed prescription refills and appointment scheduling; 55 percent had reviewed the need to transition or a specific transition plan; and fewer than 20 percent had received any written transition materials.
The group receiving care from "adult" doctors had transitioned away from pediatric care at age 19, on average, mainly after a recommendation by their pediatric provider; 63 percent said they had received a specific referral for an adult diabetes provider and 66 percent felt mostly/completely prepared to transition - and these patients had less diabetes-related distress and higher treatment adherence.
However, 21 percent of the adult-care group reported a gap of more than six months between pediatric and adult diabetes care. Those with fewer pretransition pediatric visits or who felt unprepared for transition were more apt to have a gap more than six months between pediatric and adult care.
Transition preparation counseling was not associated with self-reported blood sugar control in either group.
This study “offers a national perspective of young adult diabetes care experiences on both sides of the transition,” the authors note in their paper.
Recommended components of transition preparation include counseling on diabetes self-management and health risk behaviors, written transition plans, and specific adult provider referrals, they point out.
“We are still seeing deficiencies in important components of pediatric transition preparation counseling,” Dr. Garvey told Reuters Health. “Prioritizing transition preparation and planning may increase young adult engagement in care across the transition, and help protect them from gaps in care and adverse outcomes.”
SOURCE: bit.ly/2hQWncN Diabetes Care, online December 22, 2016.