Transition can be described as:
"the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-orientated health care systems."(1)
Effective transition from paediatric to adult services for young people with diabetes is necessary for the following reasons:
— Evidence suggests that transition programmes improve health outcomes and quality of life (2,3,4) and that inadequate transition has been associated with poorer prognosis (5).
— Poor clinic attendance is linked to inappropriate transition – between 10–69% of young people receive no medical follow up after transfer to adult services (7–12).
— Those lost to follow up have poorer diabetes control (6,8,13), and medical crises could be averted had an individual received regular follow up and education (14).
— Adolescents with diabetes have unique health needs. Whilst coping with the biological, psychological and social transitions of adolescence they must also manage their diabetes appropriately. The impact of emotional and physical demands means that they are more susceptible to non-concordance, which may result in worsening glycaemic control.
— Behaviours that improve health outcomes in later life are laid down in adolescence, so public health policy and clinical focus on the health of young people will have important long-term health benefits (3,15,16).
— Resource implications – the cost to government of treating diabetic complications is considerable, and inadequate transition can contribute to this cost (17).
— Adolescents are a growing population in society, comprising 13–15% of the total UK population, potentially higher in certain ethnic minority groups (18). It may be cost effective to improve transition programmes for adolescents with diabetes given the growing adolescent population and the risks associated with sub-optimal diabetes control. National, regional and local healthcare commissioners should consider the consequences of failure to invest in services for young people (18).
July 2008
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