Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

Figures & data

Figure 1 Sample diabetes skills and knowledge to be addressed before transfer to adult-oriented health care.

Table 1 Best practices for health care providers working with transition-aged youth

For pediatric health care providers	Provide personalized referral to specific adult health care provider based on individualized knowledge of the patient or assist with identifying providers participating within a patient’s insurance network^Citation47,Citation48 Initiate discussion about transition early, lead expectation-setting for transition and the adult medical setting, and time the transition based on individual readiness^Citation41,Citation56,Citation57 Communicate with intended adult health care provider before transition and with patient afterward for follow-up^Citation48
Transition process	Employ a transition coordinator to remind, facilitate, and rebook appointments when necessary; follow-up on any missed appointments; ensure transfer of information from pediatric to adult providers^Citation56,Citation57,Citation63,Citation64,Citation68 Multidisciplinary “joint” (involving members of both the pediatric and adult health care teams) appointments ranging from one visit to up to 2 years before seeing solely adult providers, especially for those with history of infrequent clinic attendance^Citation57,Citation63
For adult health care providers	Consider setting up an introductory meeting with new adult patients before transition^Citation41 Provide orientation to clinic practices and take time to develop personal rapport and relationship with patients^Citation47
For any providers serving adolescents and young adults with type 1 diabetes	Encourage collaboration in doctor-patient relationship and promote the patient’s autonomy and gradual assumption of personal responsibility as developmentally appropriate^Citation48 As appropriate, involve parents as an important source of support and continually needed resource^Citation41,Citation46,Citation48 Adequately address concerns specific to this age group (ie, risky behaviors, dietary patterns, changes in living situation, insurance status, and health effects of stress)^Citation43,Citation56

Table 2 Sample resources to assist with the transition from pediatric to adult-oriented health care

Organization	Web site	Target audience	Resources
Got Transition	www.gottransition.org	Health care providers, patients, families	Information on best practices for general transition to adult-oriented health care; answers to frequently asked questions about transition
Pediatric Endocrine Society	https://www.pedsendo.org/patients_families/transition_toolkit/index.cfm	Health care providers	Toolkit to assist pediatric providers with planning for, structuring, and facilitating patient transition to adult-oriented endocrinology care
Endocrine Society	https://www.endocrine.org/education-and-practice-management/quality-improvement-resources/clinical-practice-resources/transition-of-care	Health care providers	Tools to implement in clinical practice with young adult patients preparing for and receiving care in the adult health care system
National Diabetes Education Program	http://ndep.nih.gov/transitions	Health care providers, patients, families	Transition planning checklist and clinical summary template for providers, links to information on health care and daily diabetes management for patients and families; includes in-person and online support groups
JDRF	http://typeonenation.org/resources/newly-diagnosed/t1d-toolkits/	Adult patients	Toolkits for adults with type 1 diabetes, with information about diabetes management
College Diabetes Network	https://collegediabetesnetwork.org/	Young adult patients	Resources for diabetes management during young adulthood, including diabetes at college, navigating health insurance, and addressing diabetes in personal relationships

Abbreviation: JDRF, Juvenile Diabetes Research Foundation.

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