Implementation of effective transition from pediatric to adult diabetes care: epidemiological and clinical characteristics—a pioneering experience in North Africa

Essaddam, L.; Kallali, Wafa; Jemel, Manel; Kandara, Hajer; Kammoun, Inès; Hsaïri, Mohamed; Salem, L. Ben; Bêcher, S. Ben

doi:10.1007/s00592-018-1196-x

Cited by 16 publications

(15 citation statements)

References 30 publications

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“…But none of our included studies examined the flexibility of transfer time as a sole intervention. In most studies, the timing was linked to individual HCT planning [24,30,31]. In other studies, the time of transfer was determined by an HCT coordinator [32].…”

Section: The Time Of Transfer Should Take Into Account the Characteristics Of The Disease And The Patient And Should Not Be Rigidly Linkementioning

confidence: 99%

Health care transition from pediatric to adult care: an evidence-based guideline

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Ernst

2022

Eur J Pediatr

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For consistent quality of treatment of young people with chronic health care needs, a structured health care transition (HCT) from pediatric medicine to adult medical care is essential. Currently, most countries have no guidelines on HCT based on systematic evidence research. To close this gap, guidance to support HCT was developed in Germany. Twenty-two experts in the management of adolescents and young adults with different chronic conditions and three patient representatives were invited to take part in the guideline group. Based on a systematic literature search recommendations for HCT were drafted. Where evidence was lacking, recommendations were developed using collective expert consensus. The consensus process was independently moderated using a Delphi approach. The final draft was reviewed and endorsed by all major German medical societies. The clinical recommendations provide guidance for all chronic somatic diseases. After assessment of HCT readiness, an individualized plan for HCT should be drawn up. Key elements here are a responsible coordinator, age-adapted patient education, involvement of caregivers, web-based interventions, joint visits, and a structured summary for the receiving physician. The aim is the gradual transfer of responsibility for disease management to the young person themselves. Conclusion: As only a few randomized controlled studies on HCT are available, evidence-based statements are possible for some but not all areas of HCT. However, this guideline may help to develop globally accepted standards. These standards should be established and implemented. The aim should be a reimbursement by individual national health systems to allow appropriate support for young people. What is Known:• Health care transition from pediatric to adult care is primarily organized in local settings, partly based on disease-specific guidelines.•There have been no national guidelines in Germany until now. What is New:• Here we present the general evidence-based guidelines of the German Association of Scientific Medical Societies for health care transition.• These might serve as a blueprint for further national or international health care transition guidelines.

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Section: The Time Of Transfer Should Take Into Account the Characteristics Of The Disease And The Patient And Should Not Be Rigidly Linkementioning

confidence: 99%

Health care transition from pediatric to adult care: an evidence-based guideline

Pape

Ernst

2022

Eur J Pediatr

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“…But none of our included studies examined the exibility of transfer time as a sole intervention. In most studies, the timing was linked to individual transition planning [24,30,31]. In other studies, the time of transfer was determined by a transition coordinator [32].…”

Section: Level Of Recommendationmentioning

confidence: 99%

“…Cole and co-workers observed better drug adherence, greater use of the rst appointment, fewer operations, and fewer hospital admissions in the rst two years after transfer in young patients with in ammatory bowel disease [30]. In young people with type 1 diabetes the HbA1c value improved signi cantly [31]. Jensen and colleagues showed a higher rate of successful HCT in adolescents with juvenile idiopathic arthritis after complex care coordinated by a social worker [32].…”

Section: Level Of Recommendationmentioning

confidence: 99%

“…Accordingly, the effect of a structured health summary or a patient passport is di cult to assess. In the study by Essaddam et al [31] it was part of a joint transition meeting for adolescents with type 1 diabetes. A patient card was lled out, which contained information on the patient's history, medication, and complications, as well as providing a psychosocial background and professional perspective.…”

Section: Level Of Recommendationmentioning

confidence: 99%

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Health Care Transition From Pediatric to Adult Care: an Evidence Based Guideline

Pape

Ernst

2021

Preprint

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PurposeFor consistent quality of treatment of young people with chronic health care needs, a structured transition from pediatric medicine to adult medical care is essential. Currently, most countries have no guidelines on health care transition (HCT) based on systematic evidence research. To close this gap guidance to support the transition was developed in Germany.MethodsTwenty-five experts in the management of adolescents and young adults with different chronic conditions were invited to take part in the guideline group. Based on a systematic literature search recommendations for transition were drafted. Where evidence was lacking, recommendations were developed using collective expert consensus. The consensus process was independently moderated using a Delphi approach. The final draft was reviewed and endorsed by all major German medical societies.ResultsThe clinical recommendations provide guidance for all chronic somatic diseases. After assessment of transition readiness, an individualized plan for transition should be drawn up. Key elements here are a responsible coordinator, age-adapted patient education, involvement of parents, web-based interventions, joint visits and a structured summary for the receiving physician. The aim is the gradual transfer of responsibility for disease management to the young person themselves.ConclusionAs only a few randomized controlled studies on HCT are available, evidence-based statements are possible for some but not all areas of transition. However, this guideline may help to develop globally accepted standards. These standards should be established, implemented and financed by individual national health systems to allow appropriate support for young people.

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“…A recent review by Schmidt et al (35) showed that the structured, professionally guided HCT process (planning, transfer assistance, and integration) resulted in improvements in disease-specific measures, quality of life, and self-care skills. Several studies demonstrated an improvement in the glycemic control of young T1DM patients following a structured transition program from pediatric to adult diabetes care (36)(37)(38)(39); however, the prevalence of neuropathic lesions in young patients with T1DM at the time of transition is not known. Our goal was to assess the possible neuropathic condition of this special population at the time of transition to define the potential earlier screening needs.…”

Section: Introductionmentioning

confidence: 99%

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

et al. 2021

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IntroductionThe prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care.Patients and MethodsTwenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests.ResultsT1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01).ConclusionIn this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.

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Implementation of effective transition from pediatric to adult diabetes care: epidemiological and clinical characteristics—a pioneering experience in North Africa

Cited by 16 publications

References 30 publications

Health care transition from pediatric to adult care: an evidence-based guideline

Health care transition from pediatric to adult care: an evidence-based guideline

Health Care Transition From Pediatric to Adult Care: an Evidence Based Guideline

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

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