Every day in travels to my outpatient clinics, I observe the process of maturation of my patients as they grow through kindergarten and elementary school, middle and high school and then finally on to college and in many cases graduate school.
When is it time to say to goodbye and usher our children into the adult world of endocrinology?
There has been a movement in the realm of pediatrics to study "the transitioning adolescent" to adult practice during the past few years. Protocols address this very issue to allow for successful transition of children living with chronic disease to our adult counterparts. In the latest edition of Diabetes Care, volume 34, Nov 2011, 2477-2485, a position statement authored by Anne Peters, MD, CDE, Lori Laffel, MD, MPH, and the ADA Transitions working group was released by the American Diabetes Association: "Diabetes Care for Emerging Adults: Recommendations for Transition from Pediatric to Adult Care Systems."
Why has this particular issue become so important as our children become young adults?
As children become adolescents and young adults, there are gradual changes in diabetes care responsibilities that become shifted from the parents to the adolescent and young adult. Sometimes, as we have discussed in the past, many adolescents are not quite ready to assume the responsibilities of self-care skills due to the characteristics associated with their developmental stage (impulsivity, peer group pressure, etc.) and caregivers must reestablish the previous care-giving behaviors. However, once the child moves on to college or employment the change from the pediatric diabetes multidisciplinary team to the adult endocrinology team is often fraught with anxiety and concern. Thus, preparation is required to allow for the smooth transition from pediatric to adult care. According to the authors of the position paper, the age range for transition is defined from 18 to 30 years of age, as this developmental stage is defined "emergency adulthood."
What are the Issues in the Transition from Pediatric to Adult Care?
The transition from pediatric care often by a multidisciplinary team to an adult endocrine practice is often abrupt and without preparation. There are differences between pediatric and adult care, including:
1. Focusing on the patient and not the family unit, whereas in the past diabetes self-care skills were often shared
2. Shorter visits in the adult practice
3. Healthcare information privacy
4. Freedom of choice to make own therapy decisions
As such, upon transition to adult care, there are many barriers to success including
1. Ability of glycemic control in emerging adults
2. Loss to follow-up due to competing distractions (college, employment, insurance concerns)
3. Increased risk of complications (severe hypoglycemia, Diabetic ketoacidosis)
4. Psychosocial issues
a. Mental illness onset
b. Anxiety
c. Eating disorders
d. Relationship stresses
5. Sexuality concerns:
a. Pregnancy
b. Sexual orientation and gender concerns
