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Transitioning to Adult Care

by Jean Roemer, MSN, MN, CPNP, CDE

If you look at the history of human evolution, back to the earliest days of hunter-gatherer groups and agricultural settlements, physical and psychosocial maturity occurred at approximately the same time. In fact, physical maturity probably slightly followed psychological maturity. Even at the time of the industrial revolution, some 200 years ago, this was the case.

However, since then, biological maturity has come far in advance of psychological maturity, and interestingly, where they used to coincide, now these two areas have no overlap. Physical maturity comes at or around 12–13 years for girls and 12–15 years for boys, while psychological maturity may not be achieved for another 25 or so more years. Some developmental theorists today even suggest that in our current culture, the late adolescent period can extend until age 40! Youth in our society are getting married later than previous generations (or not marrying at all), frequently moving back under their parents’ roof during some portion of their adulthood, and often taking a long time to become established in a job or career and to start a family.

In view of this mismatch, and recognizing that young adults with diabetes are often underserved for many reasons, the American Diabetes Association, American Association of Diabetes Educators, and JDRF (formerly known as the Juvenile Diabetes Research Foundation) have all recently called for research into and development of better and more accessible programs that assist young adults in obtaining the diabetes care they need.

The current system
The time of transitioning from pediatric to adult care usually coincides with other life events such as graduating from high school, beginning college, starting a job, and/or moving out of the family home. However, the age at which a teen or young adult leaves pediatric care is not universally set and often depends on where the person receives care, the number and type of providers in the practice, and the expertise of those providers in both pediatric and adult diabetes. Most primary-care pediatricians will discharge their patients to adult care at age 18 or graduation from high school, whichever comes later.

At the Children’s Hospital of Pittsburgh-UPMC, where I work, we can continue to see patients up until their 24th birthday, if necessary, although that is not the norm. Many larger medical settings and children’s hospitals are similar. If a teen is developmentally delayed or continues to be followed in another pediatric specialty clinic such as cystic fibrosis or cardiology, we will continue to follow them so as to keep all of their care in one place. Otherwise, we strive to individualize care and assist young adults in finding a place to go where they will feel comfortable.

Personally, I think it makes sense for pediatric providers to follow college students at least through the first term or even first year if the student can get to his appointments. Everything in the student’s life is changing, and having a health-care provider who knows him is one area of stability. If distance or a student’s schedule prevents him from getting to diabetes care appointments, however, he needs to switch to a health-care provider who is nearer geographically or whose office hours can accommodate him.

Easing the transition
To help make your child’s transition to adult care as smooth as possible, begin talking about it early — as early as middle school, but at the latest while your teen is still in school. Talk to your diabetes providers about any transition programs that might be available (at a nearby children’s hospital, for example) and about where they refer patients. Talk to other parents of youth who have moved to adult care to see who is liked in the community.

If your college student is going to be away at school, find out who the diabetes providers are in the area, and try to find one who is experienced in treating diabetes in college students. Ask your current diabetes care provider if he can recommend anyone, talk to an administrator in the school’s student health center, or check the Clinician Directory and Search page of the National Committee for Quality Assurance Web site, http://recognition.ncqa.org, for recognized diabetes care providers in the area. It is especially important to have an established local health-care provider in case of emergency. Once your student is at school, prompt him to be seen at three-month intervals.

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