The American Diabetes Association recently released a position statement which stated that, in helping young people transition into more responsible roles for managing their own diabetes, parents should gradually transfer the responsibilities associated with the disease to their children.
However, the ADA also noted in its “Diabetes Care for Emerging Adults” position statement that most of the work in preparing young individuals for proper diabetes care in adulthood falls to health care professionals. Doctors should begin preparing young people with diabetes and their families for the transfer to an adult clinician at least a year before the switch occurs.
The ADA’s statement arrived through the ADA Transitions Working Group, a multidisciplinary group involving representatives from the American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, and the American Academy of Pediatrics. The panel of representatives reviewed issues that occur as a result of the transition from pediatric diabetes care to adult diabetes care, which affect both the patients and their health care professionals. The statement focused on individuals age 18-30 years old—an age group that the statement described as “emerging adults”—and covered both Type 1 and Type 2 diabetes. The statement was authored by Dr. Anne Peters of the University of Southern California in Los Angeles and Dr. Lori Laffel with Joslin Diabetes Center and Harvard University in Boston.
According to the statement, the transition from pediatric to adult care is a tumultuous one for diabetics; it’s described as a “high risk period” and “a perfect storm during which interruption of care is likely for multiple reasons.”
“This is a critical time when patients not only assume responsibility for their diabetes self-care and interactions with the health care system but when they become more independent,” wrote the authors. Individuals may be moving away from their parents’ homes at the time of the transition and the lack of supervision and increased independence puts them at risk for mismanaging their diabetes. The statement noted that tens of thousands of individuals in the United Sates are currently estimated to be moving from pediatric to adult diabetes care every year.
Other factors that may contribute to difficulties in managing diabetes include the loss of health insurance or inadequate coverage. There may also be a lack of professionals who are specifically trained to meet the needs of the age group. According to the statement, additional research and improved training would help health care professionals meet the medical and psychological needs of those transitioning.
The statement identified eight factors relevant to diabetes treatment that this age group faces, including poor glycemic control; higher risk of acute complications; use of alcohol, tobacco, and drugs; and the differences between adult and pediatric diabetes care. The authors noted that these factors, along with other factors that can cause gaps in diabetes treatment, can lead to increased risk of diabetes-related complications in both the short term (hypoglycemia) and long term (retinopathy and nephropathy). Young adults with diabetes also face a higher relative risk of death than those without diabetes.
The authors recommended that health care professionals providing pediatric diabetes care should offer information about medications, diabetes-related comorbidities, and the patient’s self-assessing abilities to the physicians who will be providing adult care for their patients. The preparations for the patient should be individualized and developmentally-appropriate, requiring the patient to take on responsibilities in glucose monitoring and appointment scheduling.
The statement concluded that, throughout the next decade, they expect the growth of “evidence-based strategies that support best practice for the growing numbers of young adults with type 1 and type 2 diabetes who will be making this important transition.”