Transitioning from Pediatric Clinic to Adult Clinic

Transitioning from teenage years to adulthood can be stressful for teens with diabetes and their families. The NDEP has assembled the materials below to help teens with diabetes make a smooth transition to adult health care.

The patient clinical summary (PDF) provides an at-a-glance clinical summary for the new adult care team.  It should be completed by the diabetes care team with the help of the patient to give to the adult care provider.  Included in the clinical summary is the problem list and pertinent medical history, medication name/dosing schedule, information on self monitoring, and information provided by the person transitioning to adult care.

Pediatric to Adult Health Care Transition Planning Checklist

This checklist helps the health care provider, young adult, and family discuss and plan the change from pediatric to adult health care. While a variety of events may affect the actual timing when this change occurs, below is a suggested timeline and topics for review.

1 to 2 Years before Anticipated Transition to New Adult Care Providers

  • Introduce the idea that transition will occur in about 1 year
  • Encourage shared responsibility between the young adult and family for:
    • Making appointments
    • Refilling prescriptions
    • Calling health care providers with questions or problems
    • Making insurance claims
    • Carrying insurance card
  • Review how smoking, drugs, and alcohol affect diabetes

6 to 12 Months before Anticipated Transition

  • Discuss health insurance issues and encourage family to review options
    • Assess current insurance plan, e.g. length time on family health insurance plan, COBRA, pre-existing conditions
    • Explore new insurance options – college, employer
    • Consider making an appointment with a case manager or social worker
    • Discussion of career choices in relationship to insurance issues
  • Encourage family to gather health information to provide to the adult care team
  • Review health status: diabetes control, retina (eye), kidney and nerve function, teeth and mouth, lipids (cholesterol), blood pressure, smoking status
  • Discuss issues of independence, emotional ups and downs, depression, and how to seek help

3 to 6 months before anticipated transition

  • Find out the cost of current medication(s)
  • Provide information about differences between pediatric and adult health systems and what the young adult can expect at first visit
    • Patient’s responsibilities
    • Other possible health care team members
    • Confidentiality/parental involvement (e.g., HIPAA Privacy Act and parents need permission from young adult to be in exam room, see test results, discuss findings with health care providers)
  • Help identify next health care providers
  • Discuss upcoming changes in living arrangements (e.g., dorms, roommates, and/or living alone)

Last Few Visits

  • Review and remind of above health insurance changes, responsibility for self-care
  • Obtain signature(s) for release for transfer of personal medical information and for pediatric care providers to talk with the new adult health care providers
  • Identify new adult care physician
    • If known – request consult (if possible) and transfer records
    • If unknown – ask teen to inform your office when known to transfer records and request consult
  • Review self-care issues and how to live a healthy lifestyle with diabetes
    • Medication schedules
    • Self-monitoring of blood glucose schedule
    • Meal planning, carb counting, etc
    • Physical activity routine and its effects on blood glucose
    • Crisis prevention-management of hypoglycemia (low blood glucose), hyperglycemia (high blood glucose), and sick days
    • Need for wearing/carrying diabetes identification
    • Care of the feet
    • Oral/dental care
    • Need for vision and eye exams
    • Preconception care (preparing for a safe pregnancy and healthy baby)
    • Immunizations
    • Staying current with the latest diabetes care practice and technology
  • Suggest options for a diabetes education course