The Transition Challenge

Youth living with diabetes face potential risks

In many countries, including Canada, youth living with diabetes (or other chronic conditions) are required to move from the paediatric to adult healthcare system usually at age eighteen.

That ‘shift’ can be problematic for youth depending on where they are located, the family support and healthcare resources available and easily accessible, their own acquired skill in self-management of their condition, and the extent to which they have been assisted with prior planning to ‘be ready’ for the event.

The teenage years bring on many natural diversions and new pressures that can affect the propensity for youth to pay proper, continuing attention to managing their personal health.


In 2008, a paper entitled, “Translating Transition: a critical review of the diabetes literature” authored by Nakhla M, Daneman D, Frank M, Guttmann A, was published in
J Pediatr Endocrinol Metab. 2008 Jun;21(6):507-16.

The Abstract of that paper includes:

[a statement of the issue]
Effective transition to an adult diabetes care provider is a significant component of care in adolescents with diabetes mellitus. During this period adolescents are at risk of dropping out of medical follow-up, an action which may interfere with their future physical and psychological well-being.

[a statement of results from the study conducted by the authors]
The results of the studies examined demonstrate a decrease in diabetes care visits following transition and that improvement in clinic attendance may be achieved through: (1) implementing an educational transition program; (2) having a transition care coordinator; and (3) having a young adult transition clinic attended by both adult and pediatric physicians.

[a comment on the remaining ‘gaps’]
Despite the recognized importance of successful transition for adolescents with diabetes, studies on the subject remain sparse, highlighting the need for further research to determine both the magnitude of the problem as well as the impact of interventions to improve the processes of transition.


In 2016, and for some time to come, all of the above observations remain valid and relevant as descriptors of the current state of the art.

Healthcare professionals have been concerned about this issue for decades. Despite that, the support available for youth in transition continues to range from excellent to pragmatically non-existent. The available resources in many cases are ‘stretched’ and this reality is being amplified as the number of children and youth contracting diabetes increases. Until very recently, the focus of most studies seeking to improve the support processes has been on Type 1 diabetes.

Youth living with Type 1 diabetes are most likely to receive some degree of help because of the severity of their condition which means, generally, they are ‘known’ to the system and have likely been under reasonably continuous monitoring. Even so, there is no ‘guarantee’ that their transition will be without challenges.

Why is this a major concern?

Youth living with diabetes are at significant risk of developing multiple complications if they are not diligent in adhering to the essential protocols for managing their condition safely and effectively.

It is now widely agreed that the number of children and youth with Type 2 diabetes is escalating rapidly and that is true for every country in the world. It is no longer accurate to label Type 2 as “adult onset diabetes”. Children as young as 8 are contracting Type 2 diabetes. Type 1 diabetes is also on the rise among children and youth.

So, a key question is, “If Transition support processes and resources largely focused on Type 1 are already ‘stretched’, how will we cope with a continuing increase in demand that is further amplified by the now rapidly escalating numbers of Type 2?”

It is the case that the support required for Type 2 is ‘different’ than for Type 1 and the potential risk for some is probably less but their need for appropriate help is no less important.

The onset of diabetes can create, or amplify existing, mental health issues and thereby bring further complexity to the healthcare support needs.

Adding to our challenges to protect our youth is the unfortunate fact that many do not realize they have diabetes. The longer that state continues, the greater the risk of contracting serious complications.

An equally unfortunate fact is that ‘no one’ is counting the children living with diabetes in any systematic, consistent or sustained manner. Predictive ‘models’ and various ‘snapshots in time’ do exist but, so far, reliable quantification, a solid basis for establishing trends, and consistent routine collection of essential data are such as to make our ability to ‘size’ the problem elusive at best. That adds to the challenge for healthcare providers, administrators and planners trying to predict the required resources and attendant escalating cost burden for the system.

…. more

 

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