When it becomes time for a teen or young adult to leave his childhood diabetes care providers and move on to adult care providers, it is common for both the young person and his parents to feel some anxiety about making the transition. Families are reluctant to leave a place where they know the people, have been well cared for, are comfortable, and know what to expect. While some providers encourage their patients to seek adult care at age 18, most are willing to be flexible, based on an individual patient’s needs and situation. However, at some point, young adults are usually better served by going to an adult care provider, and the switch must be made.
A vulnerable time of life
Ideally, a young adult will have achieved a high level of self-sufficiency in his diabetes care by the time he transitions to an adult care provider. Unfortunately, this is not always the case. It is now fairly well recognized that on the whole, young adults with diabetes are a very vulnerable group. The reasons for this are many and include developmental, cultural, societal, and economic factors.
Young people who leave their parents’ home to go to college often have trouble with their diabetes care because other priorities, such as schoolwork, a job, and socializing, take precedence. Diabetes care at college may be complicated by a lack of spending money, institutional meals or reliance on fast food, busy schedules, late-night studying (or other activities), lack of sleep, and alcohol use. Students often try to fit in doctor and other diabetes care appointments over holidays and breaks, but the result is often fewer, or more widely spaced, appointments than the ideal, which is to see a health-care provider every three months. Even students with the knowledge, expertise, and tools to make changes to their diabetes regimen on their own often neglect to upload their pumps and meters and analyze the data that would enable them to make those changes.
Young people who stay at home and either attend a local school or go to work often continue to have some parental oversight of their diabetes care, although parents may be trying to let go and foster independence. However, the pressures and problems that are typical of this age tend to cause diabetes care to be a low priority. Some youths continue to consider diabetes management as belonging to their parents, because their parents are around and vigilant, and they do not “own” their diabetes or feel responsible for it.
Young adults who move out of their parents’ home to work — or to seek work — may be most at risk because they often have a low income, few benefits (such as health insurance), little or no support in their diabetes care, and unreliable access to transportation.
Unfortunately, many people in their late teens and twenties do not seek diabetes care at all or seek it inconsistently. They may not have good health insurance coverage (and millions have no health insurance), or they may be enjoying their apparent freedom from the tasks of diabetes when not under parental supervision. This group often neglects self-care until problems begin to emerge. Sometimes by then it is too late to reverse the effects of multiple years of poor diabetes control, and complications emerge just as these people are starting a family or a career. This is a sad and preventable situation.
A physical–psychological mismatch
Developmental theory has taught that there are traditionally three periods of adolescence, each with its own characteristics: Early adolescence generally is ages 10–13, middle is 14–17 years, and late has been described as 18–20 years or older. Theory also proposes that at the end of the adolescent period, the person will have established a self-identity and emotional separation from the family. The other end-point of this developmental period is child-bearing.