Diabetes Care for Emerging Adults:Recommendations for Transition FromPediatric to Adult Diabetes Care Systems

University of Southern California Keck School of Medicine, Los Angeles, California, USA.
Diabetes care (Impact Factor: 8.42). 11/2011; 34(11):2477-85. DOI: 10.2337/dc11-1723
Source: PubMed
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Available from: Anne L Peters, Mar 31, 2014
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    • "All participants provided their individual informed consent. Age-limited inclusion criteria for the study were established because of the high attrition rates and poor health outcomes known to occur in this age group.37,38 Exclusion criteria were people with type 1 diabetes outside of the set age limits, those with type 1 diabetes not living in Australia, and carers of those with type 1 diabetes. "
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    ABSTRACT: Shared decision-making (SDM) is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM. In a web-based survey, 150 Australians aged 18-35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM. Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for "My clinician enquires about how I manage my diabetes"; 93.4% to 82.2% for "My clinician listens to my opinion about my diabetes management"; 89.9% to 74.1% for "My clinician is supportive of my diabetes management"; 93.2% to 66.1% for "My clinician suggests ways in which I can improve my self-management"; 96.6% to 85.7% for "The advice of my clinician can be understood"; 98.9% to 82.2% for "The advice of my clinician can be trusted"; and 86.5% to 67.9% for "The advice of my clinician is consistent with other members of the diabetes team". Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of agreement to SDM for all consultations was 84.3%. Focus group participants reported actively seeking clinicians who practiced SDM. A lack of SDM was frequently cited as a reason for discontinuing consultation. The dominant three themes in focus group discussions were whether clinicians acknowledged patients' expertise, encouraged patients' autonomy, and provided advice that patients could utilize to improve self-management. The majority of clinicians engaged in SDM. Young adults with type 1 diabetes prefer such clinicians. They may fail to take up recommended health services when clinicians do not practice this component of patient-centered care. Such findings have implications for patient safety, improved health outcomes, and enhanced health service delivery.
    Patient Preference and Adherence 04/2014; 8:423-35. DOI:10.2147/PPA.S57707 · 1.68 Impact Factor
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    • "Young adults with T1D are of particular interest as they are recognized as being more technologically experienced [43, 44], but have high attrition rates from diabetes health services [45, 46] and suffer worse health outcomes [45]. In order to attract young adults to take up recommended health services, there is a strong imperative to make those services more patient-centered; that is that the services meet the patients’ needs and preferences. "
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    ABSTRACT: Clinician-led diabetes education is a fundamental component of care to assist people with Type 1 diabetes (T1D) self-manage their disease. Recent initiatives to incorporate a more patient-centered approach to diabetes education have included recommendations to make such education more individualized. Yet there is a dearth of research that identifies patients' perceptions of clinician-led diabetes education. We aimed to describe the experience of diabetes education from the perspective of young adults with T1D. We designed a self-reported survey for Australian adults, aged 18-35 years, with T1D. Participants (n = 150) were recruited by advertisements through diabetes consumer-organizations. Respondents were asked to rate aspects of clinician-led diabetes education and identify sources of self-education. To expand on the results of the survey we interviewed 33 respondents in focus groups. Survey: The majority of respondents (56.0%) were satisfied with the amount of continuing clinician-led diabetes education; 96.7% sought further self-education; 73.3% sourced more diabetes education themselves than that provided by their clinicians; 80.7% referred to diabetes organization websites for further education; and 30.0% used online chat-rooms and blogs for education. Focus groups: The three key themes that emerged from the interview data were deficiencies related to the pedagogy of diabetes education; knowledge deficiencies arising from the gap between theoretical diabetes education and practical reality; and the need for and problems associated with autonomous and peer-led diabetes education. Our findings indicate that there are opportunities to improve clinician led-diabetes education to improve patient outcomes by enhancing autonomous health-literacy skills and to incorporate peer-led diabetes education and support with clinician-led education. The results provide evidence for the potential value of patient engagement in quality improvement and health-service redesign.
    02/2014; 5(1). DOI:10.1007/s13300-014-0056-0
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    • "The ADA level-of-evidence grade, as shown in Table 1, is provided in parentheses. This part excerpted ADA position statement (14 recommendations and level of evidence) for emerging adults with diabetes4). "
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    ABSTRACT: With the increasing prevalence of diabetes mellitus in children, transitioning patients from childhood to adulthood are increasing. High-risk behaviors and poor glycemic control during the transition period increase the risk for hypoglycemia and hyperglycemia as well as chronic microvascular and macrovascular complications. Discussions regarding complications and preparations for transition must take place before the actual transition to adult care systems. Pediatric care providers should focus on diabetes self-management skills and prepare at least 1 year prior to the transfer. Pediatric providers should also provide a written summary about previous and current glycemic control, complications and the presence of mental health problems such as disordered eating behaviors and affective disorders. Transition care should be individualized, with an emphasis on diabetes self-management to prevent acute and long-term complications. Regular screening and management of complications should proceed according to pediatric and adult guidelines. Birth control, use of alcohol, smoking and driving should also be discussed. Barriers to self-management and care must be recognized and solutions sought. The goals of transitional care are to effectively transition the diabetic patient from the pediatric to adult care system with less elapsed time in between and to improve post-transition outcome. Previous studies regarding diabetes transitional care programs including patient education programs, medical coordinators and auxiliary service systems reported promising results. However, there is a lack of evidence regarding best practices in transition care. Further studies are needed to provide evidence based transitional care programs that take both medical and psychosocial aspects of diabetes care into consideration.
    09/2013; 18(3):106-110. DOI:10.6065/apem.2013.18.3.106
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