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Diabetes transition to adult care

Katharine C Garvey, Nicole C Foster, Shivani Agarwal, Linda A DiMeglio, Barbara J Anderson, Sarah D Corathers, Marisa E Desimone, Ingrid M Libman, Sarah K Lyons, Anne L Peters, Jennifer K Raymond, Lori M Laffel
OBJECTIVE: Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. We developed a survey to evaluate transition experiences in two groups of young adults with type 1 diabetes, before (PEDS) and after (ADULT) transition to adult care. RESEARCH DESIGN AND METHODS: We fielded an electronic survey to young adults (18-<30 years) at 60 T1D Exchange Clinic Registry centers. RESULTS: Surveys were completed by 602 young adults, 303 in the PEDS group (60% female, age 20 ± 2 years) and 299 in the ADULT group (62% female, age 24 ± 3 years)...
December 22, 2016: Diabetes Care
Alan T Schultz, Arlene Smaldone
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model...
December 6, 2016: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
Elizabeth A Pyatak, Paola A Sequeira, Cheryl L P Vigen, Marc J Weigensberg, Jamie R Wood, Lucy Montoya, Valerie Ruelas, Anne L Peters
PURPOSE: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. METHODS: Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months...
November 23, 2016: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
Patricia Garnica
BACKGROUND: Diabetes is a common chronic condition among adults that can complicate the transition from the hospital to the community. Hospital readmission is an important contributor to total medical expenditures and is an emerging indicator of quality of care. Failure to acknowledge diabetes transition of care is associated with increased emergency department visits and 30-day readmissions. METHODS: Literature review of transition of care models, sample tools and processes are presented...
November 22, 2016: Current Diabetes Reviews
Maureen Monaghan, Katherine Baumann
Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care...
2016: Research and Reports in Endocrine Disorders
Jeanne M Little, Janice A Odiaga, Carla Z Minutti
For adolescents with diabetes, ineffective health care transition to adult health services may result in suboptimal adherence to medical supervision, leading to poor glycemic control, increased diabetes complications, and hospitalization. Despite national recommendations, few youth receive the needed preparation to transition to adult health services. A data transition registry was created at a large Midwest urban academic medical center to identify patients 14 years and older with Type 1 diabetes. Thirty-nine patients with Type 1 diabetes were identified, and 33 were eligible to begin transition planning...
September 29, 2016: Journal of Pediatric Health Care
Christy Foster, Jayne Bellando, Yu-Chi Annie Wang
Type 1 diabetes is a chronic disease that can lead to severe complications if poorly controlled. Adolescents are particularly vulnerable to worsening diabetes control due to changes in physiology, family dynamics, and social interactions. Good diabetes control requires following a regimen of frequent blood glucose checks, accurate carbohydrate counts, and compliance with insulin administration. Patients who are challenged in controlling their diabetes do tend to respond to behavioral interventions; however, the effect of the intervention wanes over time...
September 1, 2016: Pediatric Annals
Shivani Agarwal, Katharine C Garvey, Jennifer K Raymond, Mark H Schutta
BACKGROUND: Healthcare transition from pediatric to adult care for young adults (YA) with type 1 diabetes (T1D) is associated with risk of adverse outcomes. Consensus recommendations exist from US professional societies on transition care for YA with T1D, but it is not known whether they have been widely adopted. We describe experiences, barriers, and provider characteristics associated with transition care in a national sample of pediatric endocrinologists. METHODS: US pediatric endocrinologists identified through the American Medical Association Physician Masterfile were sent an electronic survey...
August 31, 2016: Pediatric Diabetes
David M Levine, Michael J Healey, Adam Wright, David W Bates, Jeffrey A Linder, Lipika Samal
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) canceled Meaningful Use (MU), replacing it with Advancing Care Information, which preserves many MU elements. Therefore, transitioning from MU stage 1 to MU stage 2 has important implications for the new policy, yet the quality of care provided by physicians transitioning from MU1 to MU2 is unknown. METHODS: Retrospective longitudinal evaluation of the quality of care delivered by outpatient physicians at an academic medical center in the transition between MU1 and MU2...
August 26, 2016: Journal of the American Medical Informatics Association: JAMIA
Jane N T Sattoe, Mariëlle A C Peeters, Sander R Hilberink, Erwin Ista, AnneLoes van Staa
INTRODUCTION: To support young people in their transition to adulthood and transfer to adult care, a number of interventions have been developed. One particularly important intervention is the transition clinic (TC), where paediatric and adult providers collaborate. TCs are often advocated as best practices in transition care for young people with chronic conditions, but little is known about TC models and effects. The proposed study aims to gain insight into the added value of a TC compared with usual care (without a TC)...
2016: BMJ Open
Kris English, Emily Pajevic
In 2007, the World Health Organization published a set of International Classification of Functioning, Disability and Health (ICF) codes designed for children and youth (ICF-CY version). The ICF-CY considers typical developmental changes associated with childhood while describing health status and the effects of intervention. In this article we will describe how a specific intervention (transition planning for adolescents) can be documented with the ICF-CY. Transition planning in health care prepares adolescents and their families for the transfer from pediatric to adult health services and has been demonstrated to be an effective practice for adolescents with many types of chronic health conditions (e...
August 2016: Seminars in Hearing
Suzanne McLaughlin, Christopher Terry, Jodie Neukirch, Deborah Garneau, Deb Golding, Joanna Brown
The transitioning of youth from pediatric to adult care systems is often fraught with discontinuity, miscommunication and gaps in care. This is most significant for youth with special health care needs. A panel discussion on transitioning youth to adult care systems that was part of a learning collaborative held by The RI Care Transformation Collaborative (CTC) is presented here, illustrated by a pertinent case of a youth with type 1 diabetes. [Full article available at
August 1, 2016: Rhode Island Medical Journal
Klodian Dhana, Jana Nano, Symen Ligthart, Anna Peeters, Albert Hofman, Wilma Nusselder, Abbas Dehghan, Oscar H Franco
BACKGROUND: Overweight and obesity are associated with increased risk of type 2 diabetes. Limited evidence exists regarding the effect of excess weight on years lived with and without diabetes. We aimed to determine the association of overweight and obesity with the number of years lived with and without diabetes in a middle-aged and elderly population. METHODS AND FINDINGS: The study included 6,499 individuals (3,656 women) aged 55 y and older from the population-based Rotterdam Study...
July 2016: PLoS Medicine
Longjian Liu, Xuan Yang, Yong Long, Arshpreet Kaur Mallhi, Kathan Mehta, Erol Veznedaroglu, Xiaoyan Yin
BACKGROUND AND PURPOSE: Little attention was paid to the transition of care for stroke that may partially explain the long-term trend of stroke rates. We aimed to test the trend of hospitalization attributable to stroke in US adults. METHODS: Data from National Hospital Discharge Surveys 1980-2010 in patients aged ≥18 (n = 6,527,304) were analyzed to examine the trend of patients with first-list diagnoses of stroke. Stroke comorbidities were classified in stroke patients with second- to seven-listed diagnoses of coronary heart disease, hypertension, diabetes, arrhythmias, or hyperlipidemia...
July 13, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Hood Thabit, Roman Hovorka
The artificial pancreas (closed-loop system) addresses the unmet clinical need for improved glucose control whilst reducing the burden of diabetes self-care in type 1 diabetes. Glucose-responsive insulin delivery above and below a preset insulin amount informed by sensor glucose readings differentiates closed-loop systems from conventional, threshold-suspend and predictive-suspend insulin pump therapy. Insulin requirements in type 1 diabetes can vary between one-third-threefold on a daily basis. Closed-loop systems accommodate these variations and mitigate the risk of hypoglycaemia associated with tight glucose control...
September 2016: Diabetologia
Antoine Rachas, Delphine Lefeuvre, Laurence Meyer, Albert Faye, Nizar Mahlaoui, Elise de La Rochebrochard, Josiane Warszawski, Pierre Durieux
CONTEXT: Appropriate outcomes are required to evaluate transition programs' ability to maintain care continuity during the transfer to adult care of youths with a chronic condition. OBJECTIVE: To identify the outcomes used to measure care continuity during transfer, and to analyze current evidence regarding the efficacy of transition programs. DATA SOURCES: PubMed (1948-2014), Web of Science (1945-2014), Embase (1947-2014), and the reference lists of the studies identified...
July 2016: Pediatrics
Sarah J Beal, Ilka K Riddle, Jessica C Kichler, Amie Duncan, Andrea Houchen, Lori Casnellie, Jason Woodward, Sarah D Corathers
OBJECTIVE: Identifying differences in transition readiness according to chronic condition is essential for understanding whether special emphasis within specific populations is warranted. Youth with chronic conditions (type 1 diabetes, Turner syndrome, spina bifida, autism spectrum disorder [ASD]) representing various types of impairments were compared with youth without chronic conditions. It was hypothesized that differences would be observed according to condition type, with youth with cognitive/behavioral conditions showing less readiness than youth with other conditions and youth without chronic conditions showing the highest levels of transition readiness...
September 2016: Academic Pediatrics
Sheila M Quinn, Jodie M Ambrosino, Elizabeth A Doyle, K Weyman, William V Tamborlane, Ania M Jastreboff
OBJECTIVE: Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. METHODS: Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised...
September 2016: Endocrine Practice
Maria I Creatore, Richard H Glazier, Rahim Moineddin, Ghazal S Fazli, Ashley Johns, Peter Gozdyra, Flora I Matheson, Vered Kaufman-Shriqui, Laura C Rosella, Doug G Manuel, Gillian L Booth
IMPORTANCE: Rates of obesity and diabetes have increased substantially in recent decades; however, the potential role of the built environment in mitigating these trends is unclear. OBJECTIVE: To examine whether walkable urban neighborhoods are associated with a slower increase in overweight, obesity, and diabetes than less walkable ones. DESIGN, SETTING, AND PARTICIPANTS: Time-series analysis (2001-2012) using annual provincial health care (N ≈ 3 million per year) and biennial Canadian Community Health Survey (N ≈ 5500 per cycle) data for adults (30-64 years) living in Southern Ontario cities...
May 24, 2016: JAMA: the Journal of the American Medical Association
Huaqiong Zhou, Pamela Roberts, Satvinder Dhaliwal, Phillip Della
AIMS AND OBJECTIVES: This paper aims to provide an updated comprehensive review of the research-based evidence related to the transitions of care process for adolescents and young adults with chronic illness/disabilities since 2010. BACKGROUND: Transitioning adolescent and young adults with chronic disease and/or disabilities to adult care services is a complex process, which requires coordination and continuity of health care. The quality of the transition process not only impacts on special health care needs of the patients, but also their psychosocial development...
November 2016: Journal of Clinical Nursing
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