Emerging adults need focus, flexibility in transition from pediatric diabetes care
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with diabetes care and education specialist and postdoctoral research fellow Julia Blanchette, PhD, RN, CDCES, about the transition from pediatric to adult diabetes care and the challenges for emerging adults living with diabetes.
Weiner: What challenges to diabetes care confront emerging adults with diabetes?
Blanchette: Data from the Type 1 Diabetes Exchange indicate that emerging adults have higher HbA1c levels than other adult age groups. Additionally, emerging adults face increased risks for psychological stressors, acute diabetes complications and lapses in diabetes care. Emerging adulthood is a challenging time in general, but especially for those living with chronic health conditions like diabetes. Emerging adults take on many life changes as some live independently for the first time and balance demands of work, education and social, financial and family obligations. These tasks are difficult and adding independent chronic disease responsibilities on top of them creates unique self-management barriers, including learning how to navigate the health care system independently, new financial responsibilities, and new health insurance or lapses in coverage on top of other life changes.
Weiner: How did you become involved with supporting emerging adults with diabetes?
Blanchette: Working with adolescents at diabetes camp opened my eyes to the many psychosocial challenges that adolescents and young adults with diabetes experience, and I wanted to do something to help support this population. I specifically became interested in improving the transition from pediatric to adult diabetes care when I experienced my own “rough” transition. Until I was 22 years, I saw a pediatric endocrinologist in my hometown. When i moved 500 miles away, I had a hard time finding an adult endocrinology provider who understood my stressful life as a graduate student still adjusting to adult responsibilities. I experienced the gaps in care first hand and then noticed the same barriers confronting my patients.
Weiner: How do pediatric and adult diabetes care differ?
Blanchette: Pediatric diabetes care and adult diabetes care are very different environments. Pediatric care is focused on the family unit, and adult diabetes self-management responsibilities are placed on the individual with diabetes. In adult care, there is a greater focus on screening and prevention of complications, as complications often present for the first time during emerging adulthood or adulthood. Emerging adults need to be educated on the different focuses and, if possible, introduced to the adult provider or clinic beforehand so they aren’t overwhelmed at their first adult visit.
Weiner: What are ways health care professionals can support emerging adults with diabetes?
Blanchette: Emerging adults are in great need of support from their health care team. During a developmental stage of so much uncertainty and change, diabetes clinicians can help emerging adults problem-solve and adapt to these changes. Emerging adults are learning to balance many new demands and need flexibility. After-hours or weekend appointments, virtual appointments and flexibility to reschedule appointments helps emerging adults make it to appointments.
Weiner: What is the role of the diabetes care and education specialist in the transition from pediatric to adult diabetes care?
Blanchette: Diabetes care and education specialists can help smooth over a lot of the gaps that currently exist when emerging adults transition from pediatric to adult diabetes care. For example, diabetes care and education specialists can often spend additional time with emerging adults to help problem-solve and identify resources. They can also help orient emerging adults to the adult practice and provide education on the differences in care and expectations from providers. They should follow up with emerging adults to see if additional support is needed during such a challenging and stressful time of life made more so by a chronic disease.
- Foster NC, et al. Diabetes Technol Ther. 2019;doi:10.1089/dia.2018.0384.
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Julia Blanchette, PhD, RN, CDCES, is a the ADCES/CBDCE Postdoctoral Research Fellow in Integrated Diabetes Management at the University of Utah College of Nursing. She continues to work as an insulin pump and CGM trainer and as a nurse at diabetes camp. She can be reached at firstname.lastname@example.org; Twitter: @DrJuliaBlan.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at email@example.com; Twitter: @susangweiner.