Identifying the Unique Needs of Transition Care for Young Adults With Type 1 Diabetes

During the transition from adolescence to young adulthood, patients with type 1 diabetes must learn to independently manage their condition during a life stage that is often fraught with competing priorities and developmental challenges. For pediatric and adult health care providers who care for young adults with type 1 diabetes, the following are key items on the clinical agenda: 1. Identify risk factors for poor clinical outcomes and intervene therapeutically as indicated 2. Assess the young adult's developmental stage and barriers to self-care and individualize treatment goals accordingly Before the era of intensive insulin therapy, the prognosis for young adults was often poor. Bryden et al.1 reported data on a cohort of young adults in the United Kingdom with baseline assessment during 1987–1988 at a mean age of 22 years and follow-up assessment during 1999–2000 at a mean age of 35 years. During this time, there was no significant improvement in A1C, and the proportion of severe complications increased from 3 to 37%; multiple complications were more common in women. In general, diabetes outcomes have markedly improved with the advent of intensive insulin therapy. For example, in a recent analysis of long-term complications throughout 30 years for subjects in the original Diabetes Control and Complications Trial (DCCT) cohort,2 the cumulative incidences of any proliferative retinopathy and nephropathy were 21 and 9%, respectively. By comparison, the authors cite that the 25-year cumulative incidences of proliferative retinopathy and nephropathy were 40–53 and 35%, respectively, in cohorts of patients that developed their diabetes 10–20 years before the subjects in the DCCT. However, despite such improvements, intensive management during adolescence does not always translate into optimal glycemic control in young adulthood, as illustrated by follow-up data from adolescent participants in the DCCT. At the end of the DCCT, there was a statistically significant difference …