Issues Confronting Adolescents and Emerging Adults with Diabetes
Consequences of the Pediatric to Adult Care Transition Among Emerging Adults with Diabetes
6/9/2012 12:30:00 PM
6/9/2012 1:30:00 PM
, KERRY A. REYNOLDS, DIANNE K. PALLADINO, DOROTHY J.. BECKER, LINDA M. SIMINERIO, OSCAR ESCOBAR,
The transition from the pediatric to the adult health care system poses numerous challenges for youth with diabetes and their families. Whereas the pediatric health care system is family-oriented, informal, supportive and team-based, the adult health care system is person-focused, disease-oriented, formal and typically lacks team care. This health care transition occurs at a time when youth are facing multiple life changes (e.g., moving away from home, entering the workforce). Despite this volatile time, there is little systematic research that examines the effect of this transition on diabetes outcomes. In this longitudinal study, 119 youth with type 1 diabetes were surveyed during their senior year of high school (T1) and one year later (T2). We divided participants into three groups: pediatric (pediatric endocrinologist at T1 and T2;
= 64); adult (adult physician at T1 and T2;
= 26), and transition (pediatric endocrinologist at T1; adult physician at T2;
= 19). Ten participants had not seen a physician in the past year. Over time, the pediatric group had the best self-care, the transition group had the worst, and the adult group fell in between (p < .05). All groups showed deterioration in glycemic control, but the adult group showed the largest deterioration (p’s < .05). Furthermore, those in the adult group (38%) were less likely than those in the transition (74%) and pediatric groups (97%) to have obtained an A1c test at T1 and T2 (p < .05). Demographic analyses indicated that some groups (e.g., non-white, lower social status, not enrolled in college) transitioned out of pediatric care sooner than others (all
’s < .05), and that younger age at transition was linked to higher A1cs (
= -.34 at T2,
< .001). These prospective results suggest that early transition out of the pediatric health care system poses risks to diabetes health. Early preparation programs and interventions may ease the difficulties associated with this transition and mitigate negative diabetes outcomes.
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