UCSF Transition Program

1. UCSF Transition Program The Madison Clinic for Pediatric Diabetes at UCSF CRISS May 09, 2014

2. Goals of The Transition Program at Madison Clinic • provide youth with diabetes continuity of care • a seamless transition within our clinic to young adult-trained provider • a successful transfer of care. The new Madison Clinic at Mission Bay

3. Transition??? The Madison Clinic for Pediatric Diabetes at UCSF

4. Transition ??? The Madison Clinic for Pediatric Diabetes at UCSF

5. ADA: Challenges of Transition • Lack of empirical evidence on best approaches • Lack of well-defined criteria for readiness • Changing social and demographic characteristics of young adults • Gaps in health insurance • Differences in learning styles • Lack of training for HCP in care of this age group • No studies done in emerging adults with T2DM • Emergence of chronic complications The Madison Clinic for Pediatric Diabetes at UCSF

6. Transition Issues cont. • Differences between health care delivery in the peds and adult setting • Deterioration of glycemic control and other risk factors of the young adult • Loss to follow-up • Increased risk for acute complications • Emergence of chronic complications • Psychosocial issues • Sexual and reproductive health issues • Alcohol, smoking and drug use The Madison Clinic for Pediatric Diabetes at UCSF

7. Transition Issues cont. • Deterioration of glycemic control and other risk factors of the young adult • Poor control (SEARCH) • Only 32% of youth with T1DM age 13-18 meet ADA HbA1c goal • Only 18% of youth over 19 meet ADA Hba1c goal • Loss to follow-up (increase morbidity/mortality) • BDA study showed that mortality among those with T1D is 3X in men and 6X in women compared to peer group at ages 20-29 years old The Madison Clinic for Pediatric Diabetes at UCSF

8. The Madison Clinic for Pediatric Diabetes at UCSF

9. Transition Issues cont. • Increased risk for acute complications • Hypoglycemia • DKA • Emergence of chronic complications • Emergence of chronic complications • T1DM : ~ 10 % of adol with mc-alb • T2DM : ~ 30% of adol with mc-alb • Discussion: What might be putting these emerging adults at risk for severe hypo and DKA? The Madison Clinic for Pediatric Diabetes at UCSF

10. Transition Issues cont. • Differences between health care delivery in the pediatrics and adult setting • Deterioration of glycemic control and other risk factors of the young adult • Loss to follow-up • Increased risk for acute complications • Emergence of chronic complications • Psychosocial issues • Sexual and reproductive health issues • Alcohol, smoking and drug use The Madison Clinic for Pediatric Diabetes at UCSF

11. Transition Issues cont. • Psychosocial issues • Feelings of guilt and anxiety about getting off track with diabetes care • Worrying about the future and the possible complications • Depressive Symptoms • 18-20 y.o. 15-33% report depressive sxs • Emerging adults: 23-35% • > 20% of adolescent females (TODAY) • Eating Disorders • 2.4 x risk of developing ED in adolescent and post-adol females • Associated with poor control, decreased adherence, depression, increase DKA, increase microvascular comps • T2DM: 6% report binge eating and 20% reports subclinical eating disorder Diabetes Care for Emerging Adults: Recommendations for TransitionFrom Pediatric to Adult Diabetes Care Systems, Diabetes Care, November 2011 The Madison Clinic for Pediatric Diabetes at UCSF

12. SECTION HEADING Transition Issues cont. • Differences between health care delivery in the pedeatrics and adult setting • Deterioration of glycemic control and other risk factors of the young adult • Loss to follow-up • Increased risk for acute complications • Emergence of chronic complications • Psychosocial issues • Sexual and reproductive health issues • Alcohol, smoking and drug use The Madison Clinic for Pediatric Diabetes at UCSF

13. Transition Issues cont. • Sexual and reproductive health issues • Fewer than 1 in 4 adolescent females aware of fetal and maternal risk of pregnancy** • Alcohol, smoking and drug use • Alcohol and tobacco use similar to peers • Alcohol increases risk of severe hypoglycemia • Smoking increases CV risk and mc-alb • Driving risk The Madison Clinic for Pediatric Diabetes at UCSF

14. TRAiDTransition Readiness Assessment in Diabetes The Madison Clinic for Pediatric Diabetes at UCSF

15. Demographics The Madison Clinic for Pediatric Diabetes at UCSF

16. Transition Discussion The Madison Clinic for Pediatric Diabetes at UCSF

17. HbA1c profile for teens > 16 who took the TRAiD The Madison Clinic for Pediatric Diabetes at UCSF

18. Results: TRAiD The Madison Clinic for Pediatric Diabetes at UCSF

19. Results: TRAiD The Madison Clinic for Pediatric Diabetes at UCSF

20. Implemented Transition Programs • Climbing Wall + DM Education and Exercise • Back to College Night • Decoding Health Insurance • Game Night • Sex, Drugs & Rock and Roll • Psychosocial groups • Transition Day – Collaboration with JDRF, CHO, CarbDM, DYF • Youth Advisory Board The Madison Clinic for Pediatric Diabetes at UCSF

21. Marcela Arregui Reyes, MS, PMP Transition Coordinator,  UCSF Benioff Children’s Hospital Madison Clinic for Pediatric Diabetes Maureen McGrath, MS, PNP-BC, BC-ADM Associate Clinical Professor Coordinator, Diabetes Minor University of California, San Francisco Family Health Care Nursing