Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

Abstract

Whereas “transfer of care,” in essence, refers to the act of handing over care from one physician or health care team to another, “transition of care” is far more involved with the before-and-after events surrounding transfer. The transition to adult medical care has long been defined by the Society of Adolescent Medicine as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-centered health care systems.”1 The ultimate goal of such a transition is seamless, comprehensive, and developmentally appropriate health care throughout. Yet all too often, the partnership between those saying goodbye to emerging adults and those welcoming them is tenuous at best. E.A. Coleman put it succinctly as follows: “Complex problems like improving care transitions rarely can be solved with simple solutions.”2 In this article, we address the transition of adolescents with type 1 diabetes from child- and family-centered care to adult-centered care. The 2008 clinical practice guidelines of the Canadian Diabetes Association3 recommend that, “To ensure ongoing and adequate metabolic control, pediatric and adult diabetes services should collaborate to prepare adolescents and young adults for the transition to adult diabetes care.” This recommendation is supported by Grade C evidence, Level 3,4 but it fails to provide advice on the more practical hows and whens of transition. We focus here on three aspects of transition: 1 ) a model of life transitions first proposed by Hopson and Adams5 that highlights the complex psychological and psychosocial upheavals inherent in such transitions, 2 ) a brief review of the diabetes literature on the outcomes of transition, and 3 ) a review of the impact of interventions on these outcomes. More than 30 years ago, Hopson and Adams5 proposed a model of transition in an attempt to understand and manage …