Endocrine Abstracts

Background: Transition of diabetes care from adolescents to adulthood remains a challenging field due to many social, demographic, and economic factors. During the transition phase, strong emphasis should be placed on encouraging teens to assume self-care and self-management of their diabetes through guided practice of physical and practical skills needed once they transition to adult care.

Objectives: Through the Medicaid 1115 Waiver-Delivery System Reform Incentive Payment Program, UT Health has implemented an evidence-based care transitions program for diabetic adolescents graduating to adult care.

Method: The UT Health Pediatric Endocrinology team created an evidence-based plan to transition adolescent diabetic patients, starting at age 16.5, to adult care. This plan includes (i) identifying and maximizing skills for successful self-management of diabetes, (ii) coordination of transitioning care, (iii) identifying barriers to transition, (iv) creating a plan to help and encourage they continue receiving healthcare, (v) locating and facilitating an appointment with an adult physician, (vi) providing discharge prescriptions and supplies, (vii) providing school nurse orders, and (viii) follow up phone calls after discharge.

Results: We reviewed transition process of 2 years. Out of 138 patients (99 type 1 and 39 type 2 diabetes) who started the transition process, only 81 patients (59%) completed the process and were formally discharged from clinic. The remaining patients (41%) are still in the transition phase and currently being seen in clinic. We were able to make follow up appointments with adult endocrinologist for 55 patients (68%) but only 40 patients documented presence for this follow up (49%).

Conclusion: The transition of diabetes care faced many obstacles including:

1-Patients’ psychological factors

2-Financial and health insurance factors including access to diabetes care

3- Communication factors to provide feedback about adult care obtained.

Keywords: Diabetes, CTS, Manual therapy