Transitioning from Pediatric to Adult Diabetes Care
Handle with care.That’s the message that parents of young patients with diabetes should keep in mind as their children make the transition from pediatric to adult care.
“We’ve found that a lot of young adults—about ages 18 to 25—with diabetes canhave a hard time as they discover their own independence,” says TiffanyYeh, MD, assistant professor of clinical medicine and assistant attending physician atNewYork-Presbyterian Hospital.“Their care can sometimes bealow priority. Diabetes-related care, like having their kidneys and eyes checked, can fall by the wayside as they figure outotherthings in their lives.”
Dr.Yehoffers families helpful approaches for smoothing the pediatric-to-adult transition for patients with diabetes.
To start, it’s important for parents to reconsider, and then perhaps reshape,their role in their child’s medical care.
“It can be scary for parents to let go,” Dr.Yehsays. “But I do not recommend the rip-off-the-band-aid method. The transition to adult care should be gradual.”
That means gettingused to the idea of independenceearly,while children still are in their mid-teens.
“Parents can move start to become more of a partner than a manager,”Dr.Yehadds. “A lot of self-management talks should be happening before the patient ‘graduates.’”
ձavɫƬ’spediatric and adult endocrinology clinicshave created awaytoease this transition in medical care, Dr.Yehsays.
“I usually meet the patient at one of their appointments at ourpediatric facility, and then they have another appointment with me, also in that space,” she says. “After that, the patient will see me at theadult clinicacross the street.”
Though the COVID-19 pandemic has limitedthe use ofsome of ձavɫƬ’s multidisciplinary space,Dr.Yehanticipatesthatthis transition program will resumein the spring of 2021.
Certain technological advances—such as continuous glucose monitoring—have helped make it possiblefor parents to keep an eye on their child’s glucose levels. Butthat can be a “double-edged sword,” Dr.Yehsays—not every childwelcomesinput regarding their medical carejust because technology makes it possible.
“I do encourageparentsto stop‘snooping,’” Dr.Yehsays. “Even if sugar is too high or too low, your young adult may not want you to check in.”
Parents and children also should work together to create a medical care summary. They shoulddefine the diagnosisandlist medications, pharmacies, and physiciansso the information is easily availablewhen needed, or in case of an emergency.Parents also can have their children start ordering medication refills,schedulingappointments, and even stepping out of the doctor’s office so their childrenhave a chance to askquestions.
Young adults going to college orgoingaway from home for the first time should find a local endocrinologist who can help manage diabetes care. They also needa nearby pharmacy to order and manage medications.
College health centers can help with basic medical needs, Dr.Yehsays, “But for patients with Type 1 diabetes,it’s definitely a sub-specialty. The local endocrinologist is the right personand can help provide continuity of care.”