Oct. 29, 2022
Adolescence is an exciting, yet tricky time. This period of life is associated with the ups and downs of hormonal, physiological and social changes. During the adolescent years, children learn to become more independent — and with newfound independence often comes an increase in risk-taking behavior.
Ana L. Creo, M.D., a pediatric endocrinologist at Mayo Clinic in Rochester, Minnesota, says, "This is particularly true for those with chronic illnesses, such as diabetes. Type 1 diabetes is a challenging disease, particularly during the teenage years.
"It is well documented that, despite the extensive improvement in our knowledge about type 1 diabetes and the significant advancement in diabetes technology over the last two decades, adolescents with type 1 diabetes mellitus continue to have worse diabetes control, as evidenced by significantly higher average HbA1C, when compared with younger children and adults," Dr. Creo explains.
Kristina M. Babcock Donahue, L.I.C.S.W., M.S.W., a clinical social worker at Mayo Clinic's campus in Rochester, Minnesota, agrees: "Teenagers and young adults with chronic illness are at higher risk of developing risk-taking behavior, substance use disorders and mental health challenges. This is particularly challenging in children with chronic comorbidities and those experiencing psychosocial stressors.
"Because of these challenges, the pediatric and adult endocrinology divisions at Mayo Clinic have partnered to form a clinic specifically designed to support adolescents and young adults through the transition from a pediatric to an adult model of care."
How the clinic works
Alaa Al Nofal, M.D., M.B.A., with Pediatric and Adolescent Medicine at Mayo Clinic in Rochester, Minnesota, explains, "Adolescents are encouraged to join the transition clinic between ages 15 and 16, depending upon individual needs. We recommend all patients have four diabetes visits a year.
"They begin alternating visits between the pediatric and adult diabetes care teams," Dr. Al Nofal explains. "During visits in Pediatric and Adolescent Medicine, they see a multidisciplinary team including a dietitian, social worker, diabetes educator, physician and other specialists as needed. The visits are typically at least a couple of hours and include the parents for most of the visit."
Donna M. Desjardins, APRN, C.N.P., M.S., with Endocrinology, Diabetes and Metabolism, and Nutrition at Mayo Clinic in Rochester, Minnesota, says, "The adult endocrinology appointments include an adult provider with expertise in diabetes care and the pediatric social worker who is already familiar with the patient and family. The diabetes provider often sees the teen individually to truly mirror a typical visit and promote independence.
"Specific attention to risk-taking behaviors, substance use, mental health and stressors are discussed at every visit. We focus not only on addressing diabetes burnout and distress, but also on addressing the patient's stressors overall in life as they relate to the chronic illness," she adds.
To this end, the pediatric social work appointments offer mental health resources, financial and insurance information, disability rights, and relationship and communication resources. Patients also take transition readiness assessments regularly. This helps young patients work toward being more independent as they manage their diabetes.
The family and diabetes team ultimately decide the appropriate time for patients to fully transition to the adult diabetes clinic. For some patients this may happen as early as 17 to 18 years old, while others wait to transition after college.
Patient outcomes and improvements
"Adolescents and their parents have been very receptive to the diabetes transition clinic and appreciate having a specific plan to work toward increasing autonomy and independence in transition to adulthood with respect to diabetes management," says Dr. Al Nofal.
At transition clinic visits, patients acquire the skills — including how to refill medications and schedule their own appointments — they need to care for themselves as adults living with a chronic health condition. Patients also benefit from more flexibility in booking appointments and often shorter appointment times.
Overall, it's a positive experience for patients that includes consistent adult and pediatric diabetes provider visits, continued social work guidance, and collaboration between the pediatric and adult diabetes teams.
For more information
Refer a patient to Mayo Clinic.