Transition to Adult Care for Youth with Type 1 Diabetes

Abstract

Emerging adults with type 1 diabetes are at risk for poor glycemic control, gaps in medical care, and adverse health outcomes. With the increasing incidence in type 1 diabetes in the pediatric population, there will be an increase in the numbers of teens and young adults transferring their care from pediatric providers to adult diabetes services in the future. In recent years, the topic of transitioning pediatric patients with type 1 diabetes to adult diabetes care has been discussed at length in the literature and there have been many observational studies. However, there are few interventional studies and, to date, no randomized clinical trials. This paper discusses the rationale for studying this important area. We review both observational and interventional literature over the past several years, with a focus on new research. In addition, important areas for future research are outlined.

Technology Use in Transition-Age Patients With Type 1 Diabetes

“…Evidence points to a more successful transfer of care during the transition-age in patients using technology for insulin delivery and glucose monitoring (insulin pumps and CGM). [47][48][49] Larger randomized controlled trials are still needed to define patients that would most benefit from intervention, potential risks in relying on and promoting technology, and barriers to care needing to be addressed. 2.…”

Transitioning Through College With Diabetes: Themes Found in Online Forums

“…Our findings suggest that preparation for college often involves conscious efforts to become more autonomous in diabetes management, while anticipating and preparing for academic and psychosocial adaptations. The gradual transfer of responsibility for diabetes management from parent to child during the move to adulthood is both challenging and crucial, 23 and it appears that anticipating college may be a touch point for adolescents, parents, and health providers to focus those efforts. Transitioning into college requires adjusting to new environmental and lifestyle conditions, such as irregular diet and schedules, decisions such as when and how to disclose one's diabetes status, and managing stress and worries that accompany those challenges.…”

Reflections About the Health of the Brazilian Adolescent

“…Estes resultados confirmam a dificuldade de ter uma boa compensação neste grupo etário, pelas várias razões já abordadas e são também referidos em muitos estudos na literatura (Brierley, Eiser, Johnson, Young, & Heller, 2012;Garvey, Markowitz & Laffel, 2012;Garvey, Wolpert, et al 2012;Hanna 2012). A maioria dos jovens manifestou concordar com todas as representações positivas sobre a diabetes, por exemplo "ter diabetes não impede de sermos felizes", que confirma a importância de encarar as experiências da vida com otimismo e de trabalhar os pensamentos e as emoções positivas.…”

“…Como é referido em outros estudos, uma boa comunicação e relação entre o jovem e a equipa de saúde poderá favorecer a adesão ao tratamento, a compensação e a melhoria dos aspetos psicossociais (Anderson & Wolpert, 2004;Garvey, et al 2012;Hanna, 2012).…”

“…As atividades são orientadas para a promoção do desenvolvimento pessoal, não só a nível das competências relacionadas com a diabetes, mas também do bem-estar em geral, como é referido pelos jovens. Vários estudos referem os benefícios das atividades de grupo pois permitem partilhar vivências e experiências, desenvolver a autoconfiança, a auto-estima,a aceitação da diabetes e as competências de autogestão da diabetes, proporcionando estratégias inovadoras para ajudar os jovens a compreender melhor a diabetes e a ser mais autónomos no tratamento ao mesmo tempo que se divertem (Garvey, et al, 2012;Peyrot, 2008;Serrabulho, 2008;Serrabulho et al, 2008). Com base na revisão da literatura podemos verificar que as opiniões referidas pelos jovens relativamente às consultas de grupo e campos de férias, se baseiam na Teoria da Aprendizagem Social, pois enfatizam as influências dos outros jovens no auto-cuidado da diabetes e nas barreiras aos comportamentos de adesão, de modo a melhorar a auto-eficácia, ultrapassando as dificuldades (Glanz, 1999;Howells, 2002;Kaplan, Sallis, Jr., & Patterson, 1993).…”