The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature

Fleming, Elizabeth; Carter, Bernie; Gillibrand, Warren P.

doi:10.1046/j.1365-2702.2002.00639.x

Cited by 90 publications

(82 citation statements)

References 37 publications

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“…There can also be issues of coming to terms with their own HIV status, secrecy and guilt among other family members, and dealing with HIV infection in the context of the adolescent transitional stage of development 11, 12. Once ART has been started, studies have found lower rates of viral suppression in young people with perinatal HIV infection compared with adults 13, which are probably attributable to adherence issues and poor clinic attendance rather than drug efficacy, both common problems among young adults living with other chronic diseases 1, 14, 15, 16. Findings from this study support the benefit of earlier age at diagnosis where possible, and initiation of ART prior to the adolescent period, which will probably also favour improved immunological health 17.…”

Section: Discussionmentioning

confidence: 99%

Higher rates of triple‐class virological failure in perinatally HIV‐infected teenagers compared with heterosexually infected young adults in Europe

et al. 2016

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ObjectivesThe aim of the study was to determine the time to, and risk factors for, triple‐class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection.MethodsWe analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15–29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV‐1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI.ResultsThe median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4–111) vs. 8 (IQR 2–38) weeks, respectively], and highest in perinatally infected participants aged 10–14 years [49 (IQR 9–267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0−12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9−5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10–14 years when starting ART (27.7%; 95% CI 13.2−42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10–14 years, African origin, pre‐ART AIDS, NNRTI‐based initial regimens, higher pre‐ART viral load and lower pre‐ART CD4.ConclusionsThe results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.

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Section: Discussionmentioning

confidence: 99%

Higher rates of triple‐class virological failure in perinatally HIV‐infected teenagers compared with heterosexually infected young adults in Europe

et al. 2016

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“…To date, most of the published literature on transition to adult care has focused on identifying the barriers facing this population as they proceed through this period [7,8,9,10,11]. The main barriers noted relate to patients, parents, organizations, environment, and care providers [12,13].…”

Section: Introductionmentioning

confidence: 99%

Transition from Pediatric to Adult Healthcare: Assessment of Specific Needs of Patients with Chronic Endocrine Conditions

et al. 2012

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Background/Aim: Transition from pediatric to adult care is a challenging turning point. The aim was to evaluate the transition process and needs expressed by patients with chronic endocrine conditions at transition in order to ensure program optimization. Methods: Prospective assessment of the transition period was conducted through completion of standardized questionnaires given to targeted patients. Two types were created: (1) a general questionnaire (GQ) addressing universal aspects of transition, and (2) a specific questionnaire (SQ) exploring concerns related to each endocrine condition. Three endocrinopathies (congenital adrenal hyperplasia, hypogonadotropic hypogonadism and growth hormone deficiency) were selected for assessment since they present specific challenges requiring characterization. Results: Over the last decade, 244 patients in transition were registered in our department and 153 were included since they presented one of the endocrinopathies selected. A total of 73 subjects completed both the GQ and the SQ. Over 80% of the patients were satisfied with the transition process in terms of organization, accessibility and medical care. The actual age of transition corresponded for most to the age considered by patients as ideal for transition. SQs identified psychosexual issues that must be addressed more systematically. Conclusion: This study identified key elements allowing the creation of an improved transition program tailored for our center and for each endocrine condition studied.

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“…Therefore, effective care needs to encompass the various psychological, social and educational factors. To facilitate the process of transition, many pediatricians and diabetologists have concluded that transition clinics, run by multidisciplinary teams, are effective [12,13,14,15,16,17]. So far, however, little is known about the impact of transition clinics on metabolic and psychological outcomes [18, 19].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Patients’ Opinion and Metabolic Control after Transfer of Young Adults with Type 1 Diabetes from a Pediatric Diabetes Clinic to Adult Care

Busse

Hiermann²,

Galler³

et al. 2006

Horm Res Paediatr

145

190

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Background: Transferring adolescents with diabetes from pediatric to adult care remains a challenge and the outcome is often unknown. The aims of this study were to determine the patients’ perception of transfer arrangements and to analyze health care use and metabolic control. Methods: A telephone questionnaire was conducted for patients who had been transferred from the pediatric clinic to adult care between 1995 and 2003. Of 161 identified patients, 101 (58 females, 43 males, mean age 22.1 ± 2.4 years) were interviewed. Pediatric case notes and, if available (n = 44), current notes were analyzed to validate answers from the interview. Results: After transfer, 52.5% of patients changed their health care provider at least once. The mean frequency of changes was 1.47. There was a significant decrease in clinic attendance rate after transition (8.5 ± 2.3/years vs. 6.7 ± 3.2/years). Patients criticized the lack of arrangements, poor information about transfer and the specific age for transition (18 years) set by legislation. The transfer was considered a negative experience by 58 patients. The patients assumed their metabolic control (HbA1c) was better than it really was (7.5 ± 1.3% vs. 8.3 ± 1.6%, p < 0.05). Actual HbA1c from case notes pre- and post-transfer did not change significantly (8.5 ± 1.5% vs. 8.4 ± 1.7%, n = 44, p = 0.441). Conclusion: The establishment of transition clinics and closer cooperation between specialists in pediatric and adult medicine is mandatory. Such changes are demanded by patients and would ensure better uptake of health care services after transfer.

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The transition of adolescents with diabetes from the children's health care service into the adult health care service: a review of the literature

Cited by 90 publications

References 37 publications

Higher rates of triple‐class virological failure in perinatally HIV‐infected teenagers compared with heterosexually infected young adults in Europe

Higher rates of triple‐class virological failure in perinatally HIV‐infected teenagers compared with heterosexually infected young adults in Europe

Transition from Pediatric to Adult Healthcare: Assessment of Specific Needs of Patients with Chronic Endocrine Conditions

Evaluation of Patients’ Opinion and Metabolic Control after Transfer of Young Adults with Type 1 Diabetes from a Pediatric Diabetes Clinic to Adult Care

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