As children with type 1 diabetes approach adulthood, transitioning to adult care can be problematic for them and their family members.
Unfortunately, statistics tell us that when it comes time for transitioning from pediatric to adult diabetes care, 25 percent to 40 percent of emerging adults are lost to follow-up, putting them at increased risk for acute and chronic complications, said Eileen Egan, DNP, FNP-C, CDE, chief nurse practitioner at Winthrop Comprehensive Diabetes Care Center, and an adjunct clinical instructor at the State University of New York, Stony Brook.
During “Building the Bridge Between Pediatric and Adult Diabetes Care: Making the Connection” from 9:45 am to 10:15 am Saturday in the Rivergate Room, Egan will describe the development of the transition program at Winthrop University Hospital, including how staff have facilitated and created methods to achieve success.
In her review of the literature, Egan found no standardized processes or best practices, and many transition programs had mixed results with limited outcomes data. Winthrop University Hospital diabetes program team members established a structured transition program for emerging adults to move from the pediatric diabetes team to the adult diabetes team.
“We were acutely aware that this at-risk and understudied population needed more than just referrals to adult diabetes providers,” Egan said. “Therefore, we developed a program that highlighted collaboration between the pediatric and diabetes teams. Strong emphasis was placed on the uniqueness of each emerging adult as they transitioned, incorporating their family members if they chose.”
In a study of 29 emerging adults at Winthrop, age 18 to 28, transition was facilitated by joint appointment with pediatric and adult healthcare providers. Participants completed pre-and post-transition surveys measuring diabetes related distress, diabetes quality of life and perceived healthcare provider support. Egan and her team found the greatest improvement in responses to the healthcare climate questionnaire, with transitioning persons noting an ability to ask questions, feel understood and feel confident. With regard to diabetes-related distress, 44 percent reported moderate to high distress pre-transition versus 23.4 percent post-transition. Mean A1C levels were 8.7 and 8.4 pre- and post-transition. One participant was hospitalized with diabetic ketoacidosis, secondary to strep throat infection, and this individual was adherent with follow-up appointments. No chronic complications developed during the study.
For parents of emerging adults, 75 percent reported low distress and 25 percent reported moderate distress, with worries focusing on relationships with their emerging adult.
Egan noted that for diabetes educators the program is seamless, has the potential to reduce complications and healthcare costs, and gives parents continued education and involvement.
“This program will be helpful to other diabetes educators in the development of a transition process in their own practices. It will increase awareness of the global issue of transition and the need for well thought-out programs to make this potentially stressful time better,” she said. “We have an opportunity to share with our peers and learn from each other in an effort to develop best practices to help our patients successfully transition.”