Moving on: Transition of teens with type 1 diabetes to adult care

Abstract

Although often hotly debated, the issue of transition to adult diabetes care has received scant attention in the medical literature. Findings from observational studies indicate that, unless specific programs are in place, there is a significant loss to follow-up; that there tends to be more DKA episodes after transition, although metabolic control outcomes are quite variable; and that little is known about factors that may support or hinder the transition process. The intervention studies suggest that, with careful support and attention, these negative outcomes can be mitigated. Successful interventions include anticipatory guidance starting early in the course of diabetes, care ambassadors, and young adult diabetes clinics incorporating pediatric and adolescent health care professionals. The gaps in our knowledge of the transition care process remain considerable; for example, quantitative data about when and where to transition are essential, as is the impact of different transition models on metabolic control, diabetes-related hospitalization rates, and long-term complications. More qualitative outcome measures ought to assess quality-of-life issues (e.g., anxiety/depression, fear of hypoglycemia, and the impact of fear on compliance). The different approaches to transition ought to be studied in terms of their impacts on education level, job performance, interpersonal relationships, and driving. There can be no doubt that carefully performed studies have the opportunity to shed important light on the issues at hand and to replace the uniform protocols currently used in transition programs to more individualized approaches.