Transitioning Youth with Diabetes to Adult Care

Ensuring that today’s young people with diabetes move from pediatric care to adult care is critical to long-term health outcomes, says Robert Zimmerman, MD, Director of the Diabetes Center at Cleveland Clinic.

“Any gaps in care for diabetes can put people at risk for short-term and long-term health complications,” he says. “It’s typically somewhere between the age of 18 and 21, that young patients will need to begin managing their own health with the help of an adult care physician.”

The challenge is that young adults often “disappear” from the healthcare setting as they move away from home, go away to college or find full-time work. At Cleveland Clinic there are two methods to transition young patients to adult care depending on the situation.

Physician referral

Through physician referrals, some patients attend a one-on-one transition clinic with Dr. Zimmerman. “This is a great way to introduce pediatric patients to an adult provider in a safe and familiar environment,” says Cheryl Switzer, MSN, RN, CPNP, CDE, who provides these patients with diabetes education.

Other young adult patients go to shared medical appointments led by Dr. Zimmerman, a diabetes care coordinator and a diabetes educator. In both settings, the young adults fill out a transition checklist to help them with disease management. They are asked about their medications – if they know what they are and what they do and which ones are covered by insurance.

Diabetes educator Dawn Noe, RD, says one of the most common questions these young patients ask is what they can eat and how to include snack foods. “They are learning how to purchase and provide their own meals now so healthy nutrition and counting carbohydrates is an important skill we work on,” she says.

They are also asked if they know what do to if they run out of insulin. The goal is to instill in them that running out of insulin can lead to hospitalization or even death.

Ongoing Care

Dr. Zimmerman stresses that these patients should be seen by a provider at least every 3 months. These visits ensure that they are getting prescription refills for insulin and have access to devices like blood sugar meters, continuous glucose monitors and/or insulin pumps. At these visits, patients also have an A1C test (a measure of the average blood sugars over the last 3 months), cholesterol tests, a foot exam and more.

Dr. Zimmerman likens learning how to manage diabetes to learning life skills such as how to keep a job, manage finances or take care of a household. And because people mature at a different pace, he has found shared medical appointments to be a good resource for his young patients. “Not every patient is ready to manage all of their diabetes needs at the age of 18,” he says. “In a shared appointment, young adults can learn from each other.”

Education

The patients are taught the seven self-management skills of: healthy eating, staying active, problem solving, monitoring blood sugar (and other vitals), taking medications correctly, reducing health risks and coping with chronic diseases.

As the youth transition, other important teachings include understanding insurance coverage for diabetes care and how alcohol affects blood sugar. Young women learn how diabetes affects pregnancy and how to manage diabetes before, during and after pregnancy. The young men with diabetes learn that uncontrolled diabetes can lead to nerve damage that can cause erectile dysfunction.

“It is critical for these young patients to learn how to live with diabetes and take ownership of their health,” says Dr. Zimmerman. “At Cleveland Clinic, we are working with pediatrics to reach as many patients as we can to help ensure good health outcomes for life.”