PCPs can help young patients with type 2 diabetes transition to adult care

Shivani Agarwal

The prevalence of type 2 diabetes in youth is growing globally and nationally due to increases in pediatric obesity. In the United States, youth-onset diabetes rose 30.5% from 2001 to 2009, according to results from the SEARCH for Diabetes in Youth study.

In a follow-up study of SEARCH, researchers found that young adults with type 2 diabetes who transition from pediatric to adult care have substantially worse glycemic control and loss to follow-up, highlighting the need for tailored programs and policies that can help young individuals with youth-onset type 2 diabetes optimally transition to adult care.

“Young patients who get type 2 diabetes often have more severe disease at the onset whereas in adults, it is a progressively worsening disease,” Shivani Agarwal, MD, MPH, from the division of endocrinology, diabetes and metabolism at the University of Pennsylvania, told Healio Internal Medicine. “People with youth-onset type 2 diabetes often need insulin earlier, are more prone to hospitalizations at a younger age, and have a much earlier risk of diabetic complications such as kidney disease, heart disease and eye disease.”

She noted that type 2 diabetes becomes more difficult to control and the risk for complications becomes greater the longer a patient has type 2 diabetes. Additionally, patients may grow accustomed to fluctuations in low and high blood sugar, which can be harmful in both the short and long term, she said.

In the United States, youth-onset diabetes rose 30.5% from 2001 to 2009.
Photo credit: Adobe Stock

“Young adults have very specific needs,” Agarwal said. “They go through puberty, which requires higher insulin doses to control blood sugars. They are also transitioning multiple other parts of their life at the same time as taking care of their diabetes, such as work and/or school. They are also becoming more independent in their medical care and finances.”

Some individuals do not transition into adulthood well and as a result struggle with or fall out of their diabetes care, which can have detrimental effects and accelerate poor disease control and complications, according to Agarwal.

“For type 2 diabetes, most primary care providers will take care of these patients as they enter adulthood and transition to adult medical systems,” she said. “However, the adult medical field is not trained in youth-onset type 2 diabetes and likely underestimates how at risk this population really is.”

She noted that adult providers often prescribe oral medications as first-line treatment for type 2 diabetes. However, she emphasized that oral medications are likely not enough for younger patients with type 2 diabetes who need insulin.

“Careful attention needs to be paid to when patients were diagnosed with their type 2 diabetes with appropriate risk stratification and expedited care prioritized by primary care providers for this population,” Agarwal said.

“Expectations have to be tempered for young adults with type 2 diabetes,” she added. “Putting the onus on a patient who is new to the adult care paradigm with severe type 2 diabetes puts them at risk for complications. Reasonable developmentally appropriate goals and engagement of other care providers who can support the young adult during this difficult time in their life is a key strategy to ensuring the patient continues optimal diabetes care and control.” – by Alaina Tedesco

References:

Agarwal S, et al. Diabet Med. 2018;doi:10.1111/dme.13589.

Dabelea D, et al. JAMA. 2014;doi:10.1001/jama.2014.3201.

Disclosure: Agarwal reports no relevant financial disclosures.

Shivani Agarwal

The prevalence of type 2 diabetes in youth is growing globally and nationally due to increases in pediatric obesity. In the United States, youth-onset diabetes rose 30.5% from 2001 to 2009, according to results from the SEARCH for Diabetes in Youth study.

In a follow-up study of SEARCH, researchers found that young adults with type 2 diabetes who transition from pediatric to adult care have substantially worse glycemic control and loss to follow-up, highlighting the need for tailored programs and policies that can help young individuals with youth-onset type 2 diabetes optimally transition to adult care.

“Young patients who get type 2 diabetes often have more severe disease at the onset whereas in adults, it is a progressively worsening disease,” Shivani Agarwal, MD, MPH, from the division of endocrinology, diabetes and metabolism at the University of Pennsylvania, told Healio Internal Medicine. “People with youth-onset type 2 diabetes often need insulin earlier, are more prone to hospitalizations at a younger age, and have a much earlier risk of diabetic complications such as kidney disease, heart disease and eye disease.”

She noted that type 2 diabetes becomes more difficult to control and the risk for complications becomes greater the longer a patient has type 2 diabetes. Additionally, patients may grow accustomed to fluctuations in low and high blood sugar, which can be harmful in both the short and long term, she said.

In the United States, youth-onset diabetes rose 30.5% from 2001 to 2009.
Photo credit: Adobe Stock

“Young adults have very specific needs,” Agarwal said. “They go through puberty, which requires higher insulin doses to control blood sugars. They are also transitioning multiple other parts of their life at the same time as taking care of their diabetes, such as work and/or school. They are also becoming more independent in their medical care and finances.”

Some individuals do not transition into adulthood well and as a result struggle with or fall out of their diabetes care, which can have detrimental effects and accelerate poor disease control and complications, according to Agarwal.

“For type 2 diabetes, most primary care providers will take care of these patients as they enter adulthood and transition to adult medical systems,” she said. “However, the adult medical field is not trained in youth-onset type 2 diabetes and likely underestimates how at risk this population really is.”

She noted that adult providers often prescribe oral medications as first-line treatment for type 2 diabetes. However, she emphasized that oral medications are likely not enough for younger patients with type 2 diabetes who need insulin.

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“Careful attention needs to be paid to when patients were diagnosed with their type 2 diabetes with appropriate risk stratification and expedited care prioritized by primary care providers for this population,” Agarwal said.

“Expectations have to be tempered for young adults with type 2 diabetes,” she added. “Putting the onus on a patient who is new to the adult care paradigm with severe type 2 diabetes puts them at risk for complications. Reasonable developmentally appropriate goals and engagement of other care providers who can support the young adult during this difficult time in their life is a key strategy to ensuring the patient continues optimal diabetes care and control.” – by Alaina Tedesco

References:

Agarwal S, et al. Diabet Med. 2018;doi:10.1111/dme.13589.

Dabelea D, et al. JAMA. 2014;doi:10.1001/jama.2014.3201.

Disclosure: Agarwal reports no relevant financial disclosures.