Moving from paediatric to adult care
Wednesday, 19 December 2018
If you have a child with type 1 diabetes you may be wondering what happens with their care once they approach adulthood.
Typically around the age of 18 teenagers are moved (transitioned) from paediatric to adult diabetes services. This may seem daunting for both the parents and the teenager as you will be moving away from a familiar, supportive paediatric environment into adult care where the young person will have to fully manage their diabetes often without the ongoing support generally received during the paediatric years. According to Diabetes Australia’s 2007 National Review of transitional care, in the adult setting there can be a greater focus on type 2 diabetes, which may prove difficult for young people with type 1 moving into adult services.
In addition to adapting to the change in the style of diabetes care it is often at this time in a young person’s life that they are starting to deal with many other issues such as studies, relationships, increased independence and work. It is a stage in the diabetes lifespan which often sees less focus on diabetes management and poor attendance rates at clinics. These things can increase the risk of complications, so it is important to keep the young person supported and with their diabetes care at this time.
At present there is no standard transition process and the procedure for transition varies greatly between areas. For example:
Bathhurst – no established transition program.
Bathhurst is in the process of developing new systems as diabetes services have just moved to the hospital. Currently there is a paediatric clinic and an adult clinic. There is no clear timeline of movement from paediatric to adult clinic. Paediatricians provide support when a child is moved to the adult clinic.
- For 15-25 year olds with type 1 or type 2 diabetes
- Goal is to keep young people connected with their health care when they are starting to navigate relationships, study and careers in order to prevent diabetes complications.
- GP or specialist referral is needed
- Weekly afternoon clinic 2.30-6pm
- Insulin pump starts and management
- Appointment reminders
- Diabetes specialist, diabetes educator, dietitian and psychologist available
- Phone support – sick day management
- Assistance navigating the adult health system
- Services covered by Medicare
Canberra – Young adults with diabetes clinic
- Caters for patients between approximate ages of 16-23 years
- Multidisciplinary team – two diabetes specialists, dietitian, social worker, two diabetes educators
- Three Tuesdays a month from 3pm-7pm
- At the initial appointment the paediatric doctor will typically see the transitioning patient in the Young Adults with Diabetes Clinic (YADS). Then the paediatric doctor will hand over to the adult services doctor and the transitioning patient will be seen in the YADS clinic.
- An endocrinologist is on call after hours for people who need help.
Find out more
- Talk to your paediatric team to see if they have a young adult service and learn the details about it. Ideas of questions to ask:
- Is there a dedicated young adults with diabetes clinic?
- What hours does the clinic run and which day of the week?
- Which health professionals be available – endocrinologist, diabetes educator, dietitian, podiatrist?
- Does your current service have a Diabetes Liaison Coordinator?
- Will there be phone support if help is needed?
- Decide if you wish to attend a public clinic or see an endocrinologist privately.
- Find out about private endocrinologists in your area
- Ask the paediatric team
- Word of mouth – you may already be familiar with some adult endocrinologists
- Ask your GP or pharmacist about specialists in your area
- Talk to your teenager and discuss their options and preferences
- Look at the as1website for further information
- Call the NDSS helpline 8.30-5pm Monday to Friday on 1300 136 588 and ask to speak with a diabetes educator
- Learn more about transition and its importance here.