Effective transition from pediatric to adult care settings for patients with type 1 diabetes is a critically important process. Young adults are at high risk for poor diabetes outcomes, and provision of uninterrupted, high-quality care for young adults throughout the transition is an imperative goal.
The articles in this Diabetes Spectrum From Research to Practice section are based on lectures given at the American Diabetes Association's 70th Annual Meeting and Scientific Sessions held in Orlando, Fla., in June 2010. The articles provide diverse perspectives on transition and offer diabetes providers a summary of key outcomes data, a developmental model for approaching young adult patients, and practical advice and tools for educating patients and supporting them through the transition.
In reading the articles, it is useful to have some relevant terminology in mind. The transition from pediatric to adult care can be conceptualized as having “macro-level” and “micro-level” components.1 The macro level consists of the actual transfer process (i.e., the actual physical movement of patients from pediatric to adult care services) and the organizational or operational aspects of transition care. The micro level contains areas relevant for individual diabetes providers, who might be practicing in primarily pediatric or adult clinical settings. Examples of micro-level issues include providers' understanding of the challenges facing young adults with diabetes and their approach to education and support during clinical encounters.
The first article in this research section, by Norma Van Walleghem, MSc, RD, CDE, et al. (p. 9), describes an innovative example of a macro-level intervention. In Manitoba, Canada, where patients transfer to adult care at 18 years of age, Van Walleghem et al. have implemented the Maestro Project, a unique program using a “health navigator” or administrative coordinator who coordinates access to care and support services for young adults. The navigator maintains contact with young adults via telephone and e-mail and organizes a Web site, a newsletter, and group social events. The patient navigator system has significantly reduced the care dropout rate in early young adults and helped older young adults reconnect with adult medical services. Participants have reported significant value in access to care and perceived support.
Our next article, by Den is Daneman, MBBCh, FRCPC, and Meranda Nakhla, MD, FRCPC, MSc (p. 14), sets the tone for readers with a general model of life transitions and the impact of personal change. Daneman and Nakhla also offer a comprehensive summary of the literature on health care transition outcomes in type 1 diabetes and provide an overview of research on transition interventions.
The next article, by Paula Lynne Jameson, MSN, ARNP, FNP-BC, CDE, (p. 18), targets macro-level issues in care transition by providing tools for clinics to use in building education programs, as well as systems-based resources and Internet links. This article also provides very useful micro-level recommendations for clinicians regarding important diabetes-specific transition topics to include in individual clinical encounters.
Finally, our own contribution (p. 22) includes a discussion of developmental challenges faced by young adults and an overview of clinic outcomes data for young adults with type 1 diabetes. We also offer micro-level guidance on tailoring clinical encounters to fit young adults' life circumstances and readiness to engage in self-care behaviors.
Taken together, these articles provide a multifaceted overview of transition care. Additional research and interventions in transition care for patients with type 1 diabetes are very much needed at both the macro and micro levels, particularly in the United States, where transition practice is less uniform and outcomes are therefore more difficult to assess. It is our hope that these articles will stimulate dialogue among diabetes providers and investigators, leading to high-quality individual care and the planning and evaluation of new transition models.
