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Transition from paediatric to adult diabetes care

16 September 2020

Do you feel a bit out of place at the children’s diabetes centre? Are you ready for more independence and to have more say in how your diabetes is managed?

If yes, then it may be time for you, your family and your healthcare team to start discussing you making the move to adult care. Or you may even have already started having the conversation.

Moving to an adult diabetes service, also known as transitioning, is an important step for everyone with diabetes and hundreds of young people make this change every year across the UK and Ireland. The age that you actually transition, will depend on several factors, but will mostly be determined by how ready you are and the processes where you live. For the majority of young people, this happens between the ages of 16 and 18.1

Although this process is an important part of gaining independence in your diabetes management, it can have both short and long term health impacts. In the years immediately following transition, there are often reductions in the completion of some annual care processes, including HbA1c measurement - although this varies widely between centres. There are also often reductions in the number of people achieving their treatment targets and increased rates of hospital admissions for Diabetic Ketoacidosis (DKA) following transition.1 When transition takes place as planned - between 16 and 19 - this variation is at its lowest.2

How does transition work?

The actual process of transition from paediatric diabetes management will probably vary depending on where you live, your clinic and your healthcare team. It is likely that you and your family will be directly involved in planning your transition, so you will have some say in how it goes.

Timing will be flexible, but the majority of clinics will start talking about transition around 1 or 2 years before the date they would expect you to move onto adult care. Starting earlier gives you and your healthcare team time to build your experience and knowledge about managing your diabetes, as well as gradually increase your independence.

While you are learning about all of the different aspects of your diabetes, like carb counting and managing your medication, you will have a lot of support from your healthcare team. But don’t forget you can still talk to your family and friends. They can help you identify what you don’t feel confident about or comfortable with, and you can then use this information in conversations with your healthcare team.

Once you are ready to move to the adult service, there are a few different steps that may be included. These will depend on your local services and processes, but could include:

  • Solo appointments with your current team to get used to not having an adult in the room with you
  • Joint appointments with children’s and adult services
  • Attending a young adult clinic

What will change when I move to adult diabetes care?

The biggest difference you will find is the culture within an adult clinic. With the focus being more on self-management, you will find you have more responsibility and independence than ever before. You will need to continually learn how to manage your own diabetes. 

There are also things that your parents or guardians will previously have managed that you will now be responsible for, such as making and attending appointments; communicating with the clinic; and making sure they have the right contact details. Not only this, but there will be differences in the way your appointments with your new diabetes team are run, how often they are and the length of them.

How do I know if I am ready for transition?

Change of any kind can be scary, and your healthcare teams will work closely with you and your family to make sure that the transition doesn’t happen before you have everything you need. No matter how prepared you are, this is a big change and a new environment to get used to - but it is something that you will adjust to over time.

Although you now have more control over your diabetes management, and more responsibility, this doesn’t mean you have to do it without support from your family and friends. They will still be there to help you and talk things through. What you may find though, is that this new independence gives you the chance to talk to your healthcare team about topics you may not want to discuss in front of your parents or guardians, such as alcohol.

How can I support my child through transition?

Getting used to a new system and handing over to your child the control that you are used to having can be nerve wracking, but there are some things you can do to help support your child with the move to adult care.

Start by talking to them about the transition, so they know what is happening and why. You could work together to come up with a list of questions to ask your children’s diabetes team in your next appointment. It’s also important to support your child to learn what they need, both about managing their diabetes and managing the healthcare system, so they can be more independent in the future.

Finally, don’t forget to find your own support systems, speaking to other parents and guardians who have gone through the same experiences will help to relieve some of the stress and anxiety you are feeling.

Sources:

Diabetes UK, Transitioning into adult diabetes clinics https://www.diabetes.org.uk/guide-to-diabetes/young-adults/moving-clinics [accessed 22 July 2020]

National Diabetes Transition Audit, 2011-2017; published online 10 Jan 2019 https://files.digital.nhs.uk/14/B263BB/National%20Diabetes%20Transition%... [accessed 22 July 2020]

National Diabetes Transition Audit Report, 2003-2014; published online 23 Jun 2017 https://files.digital.nhs.uk/pdf/g/m/report_v1.0.pdf [accessed 22 July 2020]

Guideline for Transition Care for young people with diabetes. East of England Children and Young people’s Diabetes Network, 2nd Edition, June 2018 http://www.meht.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=22865 [accessed 22 July 2020]

Healthcare transition for adolescents and young adults with long-term conditions: Qualitative study of patients, parents and healthcare professionals’ experience. Coyne I et al. Journal of Clinical Nursing. 2019; 28: 4062-4076

Diabetes UK, Your new responsibilities in an adult clinic https://www.diabetes.org.uk/guide-to-diabetes/young-adults/moving-clinic... [accessed 22 July 2020]

Diabetes UK, What to expect when your child moves into adult diabetes care https://www.diabetes.org.uk/guide-to-diabetes/your-child-and-diabetes/mo... [accessed 22 July 2020]


The views expressed in the Accu-Chek blog are not necessarily those of Roche Diabetes Care Limited or our publishers. The content is provided for general information only. It is not intended to amount to advice on which you should rely – you must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content. Although we make reasonable efforts to ensure that the content is up to date, we make no representations, warranties or guarantees, whether express or implied, that the content is accurate, complete or up-to-date


References:


National Diabetes Transition Audit, 2011-2017; published online 10 Jan 2019 https://files.digital.nhs.uk/14/B263BB/National%20Diabetes%20Transition%20Audit%20-%202nd%20Report%20v1.0.pdf [accessed 22 July 2020]


National Diabetes Transition Audit Report, 2003-2014; published online 23 Jun 2017 https://files.digital.nhs.uk/pdf/g/m/report_v1.0.pdf [accessed 22 July 2020]