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.