Transition Care in Type 1 Diabetes. Five Questions and Five Principles

Management of type 1 diabetes mellitus during the period of adolescence to young adulthood is amongthe most challenging in the field of diabetes care. At around the age of 18 there is a physical transferof care from pediatric physicians to adult physicians. Alongside there is transfer of responsibility ofself-care from parents to the patient over a period of time. Unique medical problems encountered inthis age group include puberty induced increase in insulin requirements, an increase in psychiatriccomorbidities including substance use and abuse, disconnect with health care teams, and problems relatedto reproductive care and contraception. This is reflected in the poorer outcomes seen in this age groupincluding an increase in acute complications, increase in hospitalizations with diabetic emergencies, poorglucose control and an increase in loss to follow. The poor metabolic control during this period leads toestablishment of early chronic macro and microvascular complications. A structured transition care isa planned purposeful process that address these unique medical, psychological, and vocational needsamong these patients that smoothens out the process of transfer to adult care teams. The models thathave been proven to be useful in improving outcomes include the use of separate transition clinics, use oftransition coordinators and enrollment into young patients support groups. Regardless of the model usedthere are five overarching principles that define this process of transition care. They can be summarizedin five Cs which include: appropriate communication, assessment of self-care needs, building competence,using collaborative teams, and finally providing care and counseling for psychological issue