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Transitioning from Pediatric to Adult Diabetes Care
November 17, 2020
Handle with care. That’s the message that parents of young patients with diabetes should keep in mind as their children make the transition from pediatric to adult care.
“We’ve found that a lot of young adults—about ages 18 to 25—with diabetes can have a hard time as they discover their own independence,” says Tiffany Yeh, MD, assistant professor of clinical medicine and assistant attending physician at NewYork-Presbyterian Hospital. “Their care can sometimes be a low priority. Diabetes-related care, like having their kidneys and eyes checked, can fall by the wayside as they figure out other things in their lives.”
Dr. Yeh offers families helpful approaches for smoothing the pediatric-to-adult transition for patients with diabetes.
To start, it’s important for parents to reconsider, and then perhaps reshape, their role in their child’s medical care.
“It can be scary for parents to let go,” Dr. Yeh says. “But I do not recommend the rip-off-the-band-aid method. The transition to adult care should be gradual.”
That means getting used to the idea of independence early, while children still are in their mid-teens.
“Parents can move start to become more of a partner than a manager,” Dr. Yeh adds. “A lot of self-management talks should be happening before the patient ‘graduates.’”
Weill Cornell Medicine’s pediatric and adult endocrinology clinics have created a way to ease this transition in medical care, Dr. Yeh says.
“I usually meet the patient at one of their appointments at our pediatric facility, and then they have another appointment with me, also in that space,” she says. “After that, the patient will see me at the adult clinic across the street.”
Though the COVID-19 pandemic has limited the use of some of Weill Cornell Medicine’s multidisciplinary space, Dr. Yeh anticipates that this transition program will resume in the spring of 2021.
Certain technological advances—such as continuous glucose monitoring—have helped make it possible for parents to keep an eye on their child’s glucose levels. But that can be a “double-edged sword,” Dr. Yeh says—not every child welcomes input regarding their medical care just because technology makes it possible.
“I do encourage parents to stop ‘snooping,’” Dr. Yeh says. “Even if sugar is too high or too low, your young adult may not want you to check in.”
Parents and children also should work together to create a medical care summary. They should define the diagnosis and list medications, pharmacies, and physicians so the information is easily available when needed, or in case of an emergency. Parents also can have their children start ordering medication refills, scheduling appointments, and even stepping out of the doctor’s office so their children have a chance to ask questions.
Young adults going to college or going away from home for the first time should find a local endocrinologist who can help manage diabetes care. They also need a nearby pharmacy to order and manage medications.
College health centers can help with basic medical needs, Dr. Yeh says, “But for patients with Type 1 diabetes, it’s definitely a sub-specialty. The local endocrinologist is the right person and can help provide continuity of care.”