Transition experiences and health care utilization among young adults with type 1 diabetes

Background: The purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization. Methods: We developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center. Results: Of 291 surveys sent, 83 (29%) were undeliverable and three (1%) were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%). Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian) transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2–16.5) or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3–31.5) were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79%) were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5–24.0) compared with those receiving diabetes care from a general internist/adult primary care doctor (17%). Two-thirds (66%) reported receiving all recommended diabetes screening tests in the previous year, with no difference according to provider type. Conclusion: In this sample, transition preparation was variable and one quarter reported gaps in obtaining adult diabetes care. Nevertheless, the majority endorsed currently receiving regular diabetes care, although visit frequency differed by provider type. Because locating patients after transition was incomplete, our findings suggest the need for standardized methods to track transitioning patients

Manual of pediatric therapeutics /

Includes bibliographical references and index.Allergic and immunodeficiency disorders / Bryce A. Binstadt and Lynda Schneider -- Dermatologic disorders / Stephen Gellis -- Inflammatory disorders / Robert Sundel -- Musculoskeletal disorders / Richard G. Bachur and Peter M. Waters -- Neurologic disorders / Omar Khwaja, Alexander Rotenberg, and Scott L. Pomeroy -- Management of the child with developmental disabilities and specialized health care needs / Laurie Glader and Nedda Hobbs -- Behavioral disorders / Carolyn Bridgemohan and Barbara Burr -- Formulary / Shannon F. Manzi and Brenda Dodson.Caring for children / John W. Graef, Joanne Wolfe, and Christina Ullrich -- Principles of normal newborn, well-child, and adolescent care / Wanessa Risko and Sara Forman -- Fluid and electrolytes / Cynthia Wong and John T Herrin -- Antimicrobials and infectious diseases / Marvin B. Harper and Charlotte A. Mao -- Management of sick newborn / Tanzeema Hossain and Anne Hansen -- Emergency and intensive care / Mark I. Neuman, Michael L. McManus, and Andrew J. Capraro -- Poisoning / Alan Woolf --Renal disorders / Michelle A. Baum and Michael J.G. Somers -- Cardiac disorders / John M. Costello and Edward P. Walsh -- Management of nutritional, gastrointestinal, and hepatic disorders / Douglas S. Fishman and Athos Bousvaros -- Metabolic disorders / Edward Neilan and Deborah Marsden -- Endocrine disorders / Joseph I. Wolfsdorf and Diego Botero -- Prepubertal and adolescent gynecologic disorders / Susan H. Gray and Marc R. Laufer -- Hematologic disorders / Christy Duncan and Matthew M. Heeney -

Diabetic ketoacidosis in the time of COVID-19 and resource-limited settings: role of subcutaneous insulin

The International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018 for management of diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state 1, 2 provide comprehensive guidance for management of DKA in young people (Figure 1). Intravenous (IV) infusion of insulin remains the treatment of choice for treating DKA; however, the policy of many hospitals around the world requires admission to an intensive care unit (ICU) for IV insulin infusion. During the coronavirus 2019 (COVID-19) pandemic or other settings where intensive care resources are limited, ICU services may need to be prioritised or may not be appropriate due to risk of transmission of infection to young people with type 1 or type 2 diabetes. The aim of this guideline, which should be used in conjunction with the ISPAD 2018 guidelines1 , is to ensure that young individuals with DKA receive management according to best evidence in the context of limited ICU resources. Specifically, this guideline summarises evidence for the role of subcutaneous (SC) insulin in treatment of uncomplicated mild to moderate DKA in young people and may be implemented if administration of IV insulin is not an option. The levels of evidence follow the American Diabetes Association (ADA) evidence-grading system for 'Standards of Medical Care in Diabetes' and are presented in Table 2.3 This article is protected by copyright. All rights reserved