Transition Care in Type 1 Diabetes. Five Questions and Five Principles

Abstract

Management of type 1 diabetes mellitus during the period of adolescence to young adulthood is among
the most challenging in the field of diabetes care. At around the age of 18 there is a physical transfer
of care from pediatric physicians to adult physicians. Alongside there is transfer of responsibility of
self-care from parents to the patient over a period of time. Unique medical problems encountered in
this age group include puberty induced increase in insulin requirements, an increase in psychiatric
comorbidities including substance use and abuse, disconnect with health care teams, and problems related
to reproductive care and contraception. This is reflected in the poorer outcomes seen in this age group
including an increase in acute complications, increase in hospitalizations with diabetic emergencies, poor
glucose control and an increase in loss to follow. The poor metabolic control during this period leads to
establishment of early chronic macro and microvascular complications. A structured transition care is
a planned purposeful process that address these unique medical, psychological, and vocational needs
among these patients that smoothens out the process of transfer to adult care teams. The models that
have been proven to be useful in improving outcomes include the use of separate transition clinics, use of
transition coordinators and enrollment into young patients support groups. Regardless of the model used
there are five overarching principles that define this process of transition care. They can be summarized
in five Cs which include: appropriate communication, assessment of self-care needs, building competence,
using collaborative teams, and finally providing care and counseling for psychological issues