A new consensus report from three diabetes societies providing guidance on how to transition youth with diabetes from pediatric to adult diabetes care services has advised that planning for the transition should begin 1-2 years in advance.

The document was issued jointly by the International Society for Pediatric and Adolescent Diabetes (ISPAD), the European Association for the Study of Diabetes (EASD), and the American Diabetes Association (ADA) and published online in Diabetes Care.

“Adolescents and young adults with diabetes need uninterrupted access to specialized medical care, peer support, and safe school and work environments to enable them to gain the confidence and skills needed to independently manage their disease. Negative health outcomes in young adulthood may, in part, occur due to unsuccessful transition from pediatric to adult-based diabetes healthcare services,” said the authors, led by Carine de Beaufort, MD, pediatric endocrinologist and professor at the University of Luxembourg in Esch-sur-Alzette, Luxembourg.

Worldwide, healthcare services for young adults with diabetes are often inconsistent, the authors said, adding, “High rates of missed healthcare contacts, emergency service use, and inpatient admissions have been observed in the period of transition from pediatric to adult care, with consequent increases in risks of premature morbidity and mortality.”

Using two established methods for developing clinical guidelines and consensus reports, the 11-member panel devised an acronym for the overall approach, PROACT:

• Plan ahead
• Re-educate and review
• Involve Others
• Assess for transition readiness/outcomes
• Provide age-appropriate Care
• Track outcomes

The recommendations are divided into three sections:

In pediatric clinics (pre-transfer):

• Preparation is recommended to begin at least 12-24 months prior to the anticipated transfer date.
• Team roles should be delineated.
• Transition-specific education should be integrated, including health system navigation including finances/insurance, and readiness checklist/assessments.

During the pediatric to adult transfer (transfer):

• The age range should be flexible, from ~18 to 25 years.
• When possible, integrate a transition navigator coordinator and/or joint pediatric-adult clinics.
• Provide a list of regional adult healthcare professionals.
• Medical history should be written with input from the patient prior to transfer.
• Ensure that the appointment with an adult provider is scheduled within 3-4 months of the last pediatric visit.
• Encourage peer group/community activities.

In adult clinics (post-transfer):

• Visits should take place every 3 months during the first year of transition.
• Consider telemedicine for flexibility in access to care.
• Address knowledge gaps in self-management skills.
• Address psychosocial health, including education on emergency care.
• Monitoring and tracking should include process and outcomes indicators and a process for dealing with loss to follow-up.

“As more evidence becomes available, there will be a need to update these consensus strategies. In time, they may evolve into regular chapters in key publications, including the ISPAD clinical practice guidelines and ADA standards of care,” the authors wrote.

This work was not supported by any sponsor or funder, except for support from the EASD for a working group meeting in March 2024. The authors declared having no relationships or activities that might bias, or be perceived to bias, their work.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social