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Transition from pediatric diabetes care could be improved, researchers say

Type 1 diabetes healthcare for young people moving from pediatric doctors to an adult doctor team in the US could be improved, according to a US survey.
A team in Bosto, Massachusetts said the transition process needed better systems to provide more “efficient” ways of working.
Speaking to Reuters Health, Dr Katherine Garvey of Boston Children’s Hospital, said: “We still have some work to do in implementing the current practice guidelines regarding transition preparation and care coordination.”
“We need to develop systems to help providers provide efficient, standardised transition preparation education and counseling for youth with diabetes.”
Two groups of young adults with type 1 diabetes were asked about their experiences of transitional care. A total of 303 were still being treated by pediatrics and 299 had already moved onto the mainstream adult care.
Emotional attachment
In the pediatrician group, the average age of moving into adult care was 22 years, and two thirds said they had formed an emotional attachment to their provider. This was why they were still under their care.
By comparison, in the UK, the transition to adult care is usually at an earlier age, typically before teenagers reach 18 years old.
More than 80 per cent of the young people in the pediatric group said they had talked about general diabetes management with their healthcare team, while prescriptions and appointment making had been discussed by 60 per cent and 55 per cent had reviewed the transition or had a plan in place.
Fewer than 20 per cent had been given anything in writing about their transitio, but in the group already receiving care from the adult healthcare team the average age of transition was 19.
The majority – 63 per cent – said they had moved healthcare teams after their pediatrician had been given a specific referral. Of that group, 66 per cent said they had felt prepared for the change in healthcare and it was discovered that those people had less diabetes-related problems.
But 21 per cent said there was six months or more between their transitions to adult care.
New recommendations
The authors wrote: “The attachment [to pediatricians] has previously been identified as a barrier to transition in patients with type 1 diabetes as well as more generally in pediatric patients with chronic health conditions and their parents and is an important area to directly address in patient counseling.”
The researchers have recommended better self-management counselling, a written plan and a specific referral to the adult healthcare provider during transition.
Dr Garvey added: “We are still seeing deficiencies in important components of pediatric transition preparation counseling. Prioritising transition preparation and planning may increase young adult engagement in care across the transitio, and help protect them from gaps in care and adverse outcomes.”
The findings have been published in the journal Diabetes Care.

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