Transition planning for adolescents moving to adult diabetes management

Use of local protocols and guidelines for transition of adolescents and young adults with diabetes to adult management is encouraged. Benefits from a structured transition plan include:

• an improved glycaemic profile
• decreased episodes of diabetic ketoacidosis and severe hypoglycaemia
• higher attendance at scheduled appointments
• improved psychosocial wellbeing.

Differences between child- and adult-centred management make the transition to adult management challenging for adolescents and young adults. Specialist diabetes services for adults often lack a family and developmental focus, have shorter appointment times with a more abrupt process, and may lack consistency of healthcare providers, resulting in lack of continuity of care.

Transition of management is often considered at the time of other major life changes for an adolescent and young adult, such as leaving school, moving out of the family home, and starting a job or further education. Preparation for transition means procedures can be in place in case of an unexpected transition, or may allow for transition at a more stable time.

The following aspects contribute to successful transition to adult-centred management for adolescents and young adults:

• flexible timing of transition
• allocation of a transition case manager and, where possible, contact with consistent healthcare professionals to provide continuity of care
• use of services with a designated ‘young adult clinic’ or with an understanding of the needs of young adults
• provision for flexible consultation times, including at weekends or for extended hours
• initial joint consultations for the adolescent or young adult with healthcare professionals from both child and adult diabetes services
• clear and adequate communication between the child and adult multidisciplinary diabetes services, with inclusion of the general practitioner
• clear and well-documented management plans, provided to the adolescent or young adult and appropriate healthcare professionals, and including emergency contact numbers.

Healthcare service resources to implement a formal transition plan may be limited. In such cases, resources should be directed to the adolescents and young adults likely to be at greatest risk of not engaging with adult specialist diabetes services, such as those who have:

• glycaemic parameters that are not at target
• been hospitalised for severe hypoglycaemia or diabetic ketoacidosis
• comorbid mental health disorders including eating disorders
• a socioeconomic disadvantage
• limited engagement with their current health service (specialist diabetes service or general practice).