Diabetes Mellitus in the Transition Period: From Childhood to Adulthood

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Presentation at the Philippine College of Physicians Eastern Visayas Chapter Postgraduate Course last July 20, 2012.

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Diabetes Mellitus in the Transition Period: From Childhood to Adulthood

  1. 1. http://www.sxc.hu/photo/483163 Type 2 Diabetes Mellitus Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM in the Transition Period Chief, Medical Informatics Unit from Childhood to Adulthood Assoc. Professor 4, UPCMSaturday, August 4, 12
  2. 2. Peters et al. Diabetes Care for Emerging Adults: Recommendations for Transition from Pediatric to Adult Diabetes Care Systems. Reference Diabetes Care Nov 2011;34:2477-85Saturday, August 4, 12
  3. 3. http://www.flickr.com/photos/dullhunk/3389581452/ Diabetes transition care Peters et al. Diabetes Care for Emerging Adults: Recommendations for Transition from Pediatric to Adult Diabetes Care Systems. Diabetes Care 2011 Dearth of empirical evidence Challenges in the on best approaches transitionSaturday, August 4, 12
  4. 4. http://www.flickr.com/photos/pasukaru76/4320261170/ Fundamental differences Challenges in the in pediatric and adult transition health care providers Peters et al. Diabetes Care 2011Saturday, August 4, 12
  5. 5. http://www.flickr.com/photos/jurvetson/3031088430/ Lack of well-defined criteria to Challenges in the determine transition readiness transition Peters et al. Diabetes Care 2011Saturday, August 4, 12
  6. 6. https://www.facebook.com/AlodiaGosiengfiao Changing social and Challenges in the demographic characteristics transition of young adults Peters et al. Diabetes Care 2011Saturday, August 4, 12
  7. 7. http://www.flickr.com/photos/hawee/3527878000/ Differences in learning styles Challenges in the in the transition period transition Peters et al. Diabetes Care 2011Saturday, August 4, 12
  8. 8. http://www.flickr.com/photos/andresrueda/3454095552/ Deficiencies in training Challenges in the in care delivery for transition emerging adults with diabetes Peters et al. Diabetes Care 2011Saturday, August 4, 12
  9. 9. Approaches Issues RecommendationsSaturday, August 4, 12
  10. 10. IssuesSaturday, August 4, 12
  11. 11. http://www.sxc.hu/photo/1285834 Differences between Issues pediatric and adult care Peters et al. Diabetes Care 2011Saturday, August 4, 12
  12. 12. http://www.flickr.com/photos/aldenchadwick/4293213857/ Poor control of glycemia Issues and other risk factors Peters et al. Diabetes Care 2011Saturday, August 4, 12
  13. 13. NNHES: 56% of adults achieved A1c <7% http://www.sxc.hu/photo/1215912 Only 32% of youth with T1DM aged 13-18 y and 18% of those SEARCH for diabetes in Youth Study. J Pediatr 2009;155:688-672 aged >19 y achieved ADA targetsSaturday, August 4, 12
  14. 14. Greatest proportion of youth with T1DM or T2DM in poor glycemic control were teenagers http://www.sxc.hu/photo/1066055 One of every 4 patients SEARCH for diabetes in Youth aged >12 y had A1c >9.5% Study. J Pediatr 2009;155:688-672Saturday, August 4, 12
  15. 15. ⬆ hypertension and dyslipidemia related to obesity http://www.sxc.hu/photo/718085 ⬆Prevalence of CV risk factors SEARCH for diabetes in Youth in youth with T2DM vs T1DM Study. Diabetes Care 2006;29:1891-96Saturday, August 4, 12
  16. 16. http://www.flickr.com/photos/78428166@N00/4296824658/ Fatty liver disease is more SEARCH for diabetes in Youth common among obese children case-control study. Diabetes Care 2009;32:416-20 with insulin resistance and diabetesSaturday, August 4, 12
  17. 17. http://www.sxc.hu/photo/544230 Loss to follow-up Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  18. 18. http://www.sxc.hu/photo/65898 Increased risk for acute complications Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  19. 19. http://www.sxc.hu/photo/1159994 Psychosocial Issues Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  20. 20. http://www.sxc.hu/photo/550152 Anxiety disorders can complicate self-management of diabetes Psychosocial Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  21. 21. Depressive symptoms in DM 15-33% of adolescents (including 18 to 20 year-olds) 23-35% of emerging adults (18-28 y) Clinically significant symptoms in 20% of older adolescent females http://www.sxc.hu/photo/747912 Depression is a well-known comorbid condition. Psychosocial Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  22. 22. Poor metabolic control Reduced adherence ⬆risk of DKA ⬆risk of microvascular complications Adolescent and postadolescent women with DM Psychosocial Issues at risk for eating disorders Peters et al. Diabetes Care 2011Saturday, August 4, 12
  23. 23. 16% of teens aged 13-19 y with DM reported using birth control vs 67% of those ever sexually active Fewer than 1 in 4 young women aged 16-20 y aware of risks of pregnancy Sexual and reproductive health issues Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  24. 24. Alcohol use worsens glycemic control Smoking ⬆CV risk and risk for microalbuminuria Alcohol, smoking and drug abuse Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  25. 25. Microalbuminuria in teens: 10% T1DM and 30% T2DM Neuropathy in 20% of adolescents with DM Emergence of signs of chronic diabetes complications Issues Peters et al. Diabetes Care 2011Saturday, August 4, 12
  26. 26. Approaches Issues RecommendationsSaturday, August 4, 12
  27. 27. ApproachesSaturday, August 4, 12
  28. 28. http://www.flickr.com/photos/53370644@N06/4976497160/ Fragmented follow-up care Poorer glycemic control & ⬆ rate of hospitalization Gaps in follow-up care with a Easing the transfer decrease in MD visits after transfer process Peters et al. Diabetes Care 2011Saturday, August 4, 12
  29. 29. http://www.sxc.hu/photo/1008265 Observational studies or No published RCTS uncontrolled programs Peters et al. Diabetes Care 2011Saturday, August 4, 12
  30. 30. http://www.flickr.com/photos/alancleaver/2661425133/ Time is a major challenge to maintaining contact after transfer Peters et al. Diabetes Care 2011Saturday, August 4, 12
  31. 31. Evening hours or flexible clinics Longer visit as the initial meeting with the adult provider Provision of special clinic times exclusively for young adults up to age 30 y Provide written information re: Provide medical summary transfer process and new MD to receiving MD Peters et al. Diabetes Care 2011Saturday, August 4, 12
  32. 32. http://www.flickr.com/photos/absorbingman/6035479910/ Transfer to an adult clinic or Models of different hospital transition careSaturday, August 4, 12
  33. 33. http://www.flickr.com/photos/absorbingman/6035479910/ Transition to a combination of Models of pediatric and adult care providers transition careSaturday, August 4, 12
  34. 34. http://www.flickr.com/photos/absorbingman/6035479910/ Transfer to a young adult clinic Models of within the same pediatric hospital transition careSaturday, August 4, 12
  35. 35. Patient navigators Care ambassadors Models of Transition Coordinators transition careSaturday, August 4, 12
  36. 36. Workshops to prepare Models of the transitioning teen transition careSaturday, August 4, 12
  37. 37. Approaches Issues RecommendationsSaturday, August 4, 12
  38. 38. RecommendationsSaturday, August 4, 12
  39. 39. Prepare for the transition at least one year prior; likely during ADA Recommendation early adolescent years.Saturday, August 4, 12
  40. 40. Beyond glucose self-monitoring and insulin administration Include scheduling appointments and ensuring medication supply Gradual transfer of diabetes care ADA Recommendation responsibilities to the teenSaturday, August 4, 12
  41. 41. Inform re: differences between ADA Recommendation pediatric and adult providersSaturday, August 4, 12
  42. 42. Active problem list Summary of past glycemic control & DM- Medication list related comorbidities Summary of any mental health Assessment of diabetes problems and self-care skills referrals Pediatric provider should provide both the patient and future adult ADA Recommendation care provider a written summarySaturday, August 4, 12
  43. 43. Provide support and links to resources that ADA Recommendation could benefit the patient.Saturday, August 4, 12
  44. 44. http://www.sxc.hu/photo/693790 Directory of adult ADA Recommendation health care providersSaturday, August 4, 12
  45. 45. Schedule first appointment with adult care provider within 3-4 months of the final pediatric visit. Empower with resources to helpreconnect to care if lost to follow-up ADA RecommendationSaturday, August 4, 12
  46. 46. http://www.sxc.hu/photo/586475 Emphasize consistent use of glucose-lowering medications to ADA Recommendation prevent complications.Saturday, August 4, 12
  47. 47. http://www.sxc.hu/photo/318333 Evaluate and treat for disordered eating behaviors ADA Recommendation and affective disorders.Saturday, August 4, 12
  48. 48. http://www.sxc.hu/photo/214353 Visits q3 mos if taking insulin and q3-6 mos for T2DM not on insulin. ADA RecommendationSaturday, August 4, 12
  49. 49. Screen for micro- and macrovascular complications. ADA RecommendationSaturday, August 4, 12
  50. 50. http://www.sxc.hu/photo/440697 Discuss birth control, pregnancy planning and risks and prevention ADA Recommendation of sexually transmitted illnesses.Saturday, August 4, 12
  51. 51. Discuss use of alcohol and drugs, smoking and driving. ADA RecommendationSaturday, August 4, 12
  52. 52. Ensure that patients receive ongoing primary & preventive health care ADA Recommendation (separate from diabetes specialty care)Saturday, August 4, 12
  53. 53. Approaches Issues RecommendationsSaturday, August 4, 12
  54. 54. Thank You @endocrine_witchSaturday, August 4, 12

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