Introduction
The transition from pediatric to adult care can be difficult for young
adults with a chronic condition who require ongoing medical care, with
many families not receiving appropriate services during this
period.1 There are also clear impacts on patient
outcomes related to their move into adult care. For young adults with
type 1 diabetes, this transition period is associated with poorer
glycemic control and less frequent clinic
attendance.2,3,4,5 These young adults are also at
higher risk for complications and hospitalization in the period after
they move into adult care.5,6,7 Because of the greater
recognition of these risks, there has been more focus, in both practice
and research, on improving transition.
While there are exceptions,8,9 most studies on
transition for individuals with type 1 diabetes have focused on
practices at a single institution or program. This limited perspective
may overlook the experiences of patients who are followed at centres
without a dedicated pediatric diabetes or transition program. Taking
this approach also likely under reports the experiences of patients who
are cared for in rural or remote areas. In this article, we examine the
transition for young adults with type 1 diabetes across an entire
Canadian province: Newfoundland and Labrador (NL). Our aim is to
determine how transition is occurring across this entire jurisdiction
and to identify ways in which care delivery can be improved.
NL has one of the highest incidence rates of type 1 diabetes reported
globally (49.9/100,000; 95% CI 42.2, 57.6).10,11Still the issue of transition to adult care for patients with diabetes
has not been previously explored in the NL population. The NL population
is also interesting from a transition perspective in that the region has
a small and most rural population. Over half of the province’s
population of 528,000 live in a rural area, with a population density of
1.4 persons per square kilometer.12 Health care in NL,
including diabetes care, is delivered by four separate regional health
authorities. There is only one tertiary care children’s hospital,
located in the provincial capital. Much of the population faces
challenges in terms of accessing speciality health care services
locally, including diabetes care.13 Even though the
province has a small population, there was little understanding of how
transition care is being delivered in different regions. This lack of
understanding of current practices is a barrier to identifying and
implementing quality improvements, especially on a province-wide basis.
The situation in NL related to diabetes transition is probably similar
to that in other regions with mostly rural, widely dispersed
populations. Understanding how transition occurs in NL can then provide
insights into how the transition to adult care is managed in other
jurisdictions and the type of interventions that can used to improve
care.