• Item type: Guideline/policy recommendation
• Country: United States
• Language: English
• Author: Peters A, & Laffel, L.
• Target audience: Policy makers
• Publication Date: Nov, 2011
• http://care.diabetesjournals.org/content/34/11/2477.full

The actual change from pediatric to adult health care providers signals a more abrupt change that requires preparation by patients, their families, and their health care providers. A number of publications from the U.S. and other countries have highlighted substantial gaps in care during this transition period between pediatric and adult care that often arise in later adolescence and the subsequent developmental stage of life termed “emerging adulthood.” 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, potentially moving out of their parents’ home to attend college or to join the workforce (1). In the context of these transitions and the developmental issues of this age-group, gaps in diabetes care can result in suboptimal health care utilization, deteriorating glycemic control, increased occurrence of acute complications, emergence of chronic complications of diabetes that may go undetected or untreated, and psychosocial, behavioral, and emotional challenges. With the increasing incidence of both type 1 and type 2 diabetes in childhood, adolescence, and young adulthood, there is an increase in the absolute numbers of youth with diabetes in this transition period, highlighting the need for a framework of care and education for this population and a call for additional research in this area.

Substantial challenges relating to the transitional period include the following:

• The dearth of empirical evidence on the best approaches to the transition process

• Fundamental differences in health care delivery between pediatric and adult health care providers

• Lack of well-defined criteria for determination of transition readiness

• The changing social and demographic characteristics of young adults that may influence their utilization of health care

• Gaps in health insurance during this transitional period

• Differences in learning styles between individuals in this transition period compared with both younger children and adults beyond the period of emerging adulthood

• Deficiencies in training of health care professionals in care delivery for emerging adults with diabetes

A position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society)