3.0.0.0 TRAN­SI­TION FROM PE­DI­ATRIC TO ADULT CARE

Rec­om­men­da­tions

13.102 Pe­di­atric di­a­betes pro­viders should begin to pre­pare youth for tran­si­tion to adult health care in early ado­les­cence and, at the lat­est, at least 1 year be­fore the tran­si­tion. E

13.103 Both pe­di­atric and adult di­a­betes care pro­viders should pro­vide sup­port and re­sources for tran­si­tioning young adults. E

13.104 Youth with type 2 di­a­betes should be trans­ferred to an adult-‍ori­ent­ed di­a­betes spe­cial­ist when deemed ap­pro­pri­ate by the pa­tient and pro­vider. E

Care and close su­per­vi­sion of di­a­betes man­age­ment are in­creas­ingly shift­ed from par­ents and other adults to the youth with type 1 or type 2 di­a­betes through­out child­hood and ado­les­cence. The shift from pe­di­atric to adult health care pro­viders, how­ev­er, often oc­curs abrupt­ly as the older teen en­ters the next de­vel­op­men­tal stage, re­ferred to as emerg­ing adult­hood (177), which is a crit­i­cal pe­ri­od for young peo­ple who have di­a­betes. Dur­ing this pe­ri­od of major life tran­si­tions, youth begin to move out of their par­ents’ homes and must be­come fully re­spon­si­ble for their di­a­betes care. Their new re­spon­si­bil­i­ties in­clude self-‍man­age­ment of their di­a­betes, mak­ing med­i­cal ap­point­ments, and financ­ing health care, once they are no longer cov­ered by their par­ents’ health in­sur­ance plans (on­go­ing cov­er­age until age 26 years is cur­rently avail­able under pro­vi­sions of the U.S. Af­ford­able Care Act). In ad­di­tion to laps­es in health care, this is also a pe­ri­od as­so­ci­at­ed with de­te­ri­o­ra­tion in glycemic con­trol; in­creased oc­cur­rence of acute com­pli­ca­tions; psy­choso­cial, emo­tion­al, and be­hav­ioral chal­lenges; and the emer­gence of chron­ic com­pli­ca­tions (178-181). The tran­si­tion pe­ri­od from pe­di­atric to adult care is prone to frag­men­ta­tion in health care de­liv­ery, which may ad­versely im­pact health care qual­i­ty, cost, and out­comes (182).

Al­though sci­en­tific ev­i­dence is lim­it­ed, it is clear that com­pre­hen­sive and co­or­di­nat­ed plan­ning that be­gins in early ado­les­cence is nec­es­sary to fa­cil­i­tate a seam­less tran­si­tion from pe­di­atric to adult health care (178,179,183,184). A com­pre­hen­sive dis­cus­sion re­gard­ing the chal­lenges faced dur­ing this pe­ri­od, in­clud­ing specific rec­om­men­da­tions, is found in the ADA po­si­tion state­ment “Di­a­betes Care for Emerg­ing Adults: Rec­om­men­da­tions for Tran­si­tion From Pe­di­atric to Adult Di­a­betes Care Sys­tems” (179).

The En­docrine So­ci­ety in col­lab­o­ra­tion with the ADA and other or­ga­ni­za­tions has de­vel­oped tran­si­tion tools for clin­icians and youth and fam­i­lies (184).