Central Health Region
The Central Health Region has an outpatient pediatric type 1 diabetes practice serving approximately 30-40 patients. The outpatient clinic consists of a dietician, a diabetes nurse educator, and both pediatric and adult physicians. Transition preparation starts as early as age 10, when patients are encouraged to participate more in their appointments and start to be independent in their diabetes management. At age 16, providers begin to discuss what to expect during transition to adult care. Education topics include how to check their blood glucose, drug and alcohol use, and safe driving. Transition occurs at age 18. A lot of the early preparedness for patients has been motivated by the experiences of the clinic’s lead pediatrician, who previously had system-related difficulties maintaining the care of patients after age 18. If patients stay in the region, only their physician changes from a pediatrician to an adult internist. If the patient does not regularly use an insulin pump, a computerized device for managing insulin usage, their diabetes might be managed by their family physician rather than an internist after transition. The dietician and diabetes nurse educators at the clinic manage both children and adults, ensuring continuity of care (Table 2, Quote 3). If patients move out of the region, e.g., for educational opportunities or work, the team recommends that the young adult contacts their campus clinic and/or a family physician in their new region. The pediatrician will then provide the patient’s new physician with a patient medical summary. While recognizing that care can always improve, the team felt that their approach was effective at supporting patients who regularly attended clinic as they transition into adult care.