COMMENTARIES

46a Pract Diab Int March 2005 Vol. 22 No. 2 Copyright © 2005 John Wiley & Sons, Ltd.

There has never been a more important time for the dis-cussion and development of an organised and timelytransition from a paediatric to an adult diabetes service.As a nurse with a special interest in adolescent diabetesand transitional care issues I was delighted to be askedto provide a commentary on the article by StephenGreene and Alexandra Greene.

Young people struggle with the social, cultural andphysical changes they experience during adolescenceand, as discussed in the article, living with diabetes onlyserves to compound this. It is essential therefore that thetransitional process be ‘a multi-faceted active processthat attends to the medical, psychosocial educationaland vocational needs of adolescents as they move fromchild to adult centered care’.1

National Institute for Clinical Excellence guidanceon transitional care issues – regarding philosophy oftransition, age-banded clinics and adult and paediatriccolleagues working closely together – is to be wel-comed. Our challenge continues to be provision ofquality care that is accessible and patient centred andhelps the young person to experience an individu-

alised approach to their care provision. The articlehighlights young people’s wish for age-banded clinics.The desire for an opportunity to visit the ‘adult’ ser-vice, prior to transfer, may be in some way negated bythe introduction of more young adult transitional clin-ics where paediatric and adult medical and nursingstaff come together to provide care for these youngpeople. Preparation for these changes falls to the pae-diatric team and should be handled sensitively. Withdedicated team members these clinics run very welland can, as discussed, help in preventing ‘the lost tribeof T1D’.

Emma Thomas, Clinical Nurse Specialist andDiabetes Home Care Coordinator, BirminghamChildren’s Hospital, Birmingham, UK

Reference1. Blum RW, Garell D, Hodgmen CH, et al. Transition from

child-centered to adult health care systems for adolescentswith chronic conditions: A position paper of the Society ofAdolescent Medicine. J Adolescent Health 1993; 14: 570–576.

Adolescent diabetes: meeting the challengesof transitional careS Greene, A Greene. Changing from the paediatric to the adult service: guidance on the transition of care.Pages 41–45

It is widely accepted that children and young peoplewith type 1 diabetes (T1D) have particular needs whichdiffer from those of adults. In this issue, Stephen Greeneand Alexandra Greene offer us guidance on the transi-tion of care from paediatric to adult services. The articleis based on recent research and the National Institutefor Clinical Excellence (NICE) 2004 Guideline 15.

In attempting to answer the question ‘Why does gly-caemic control deteriorate during adolescence?’ we areoffered physiological, psychological and cultural expla-nations for the all too familiar pattern of poor metaboliccontrol in this group of patients. Interestingly, theauthors point to a ‘Western View of Adolescence’ as anegative influence on the expectations of health careprofessionals, and the health outcomes of the youngpeople concerned.

Although there are undoubtedly examples of bestpractice in transitional care throughout the UK, a num-ber of surveys reported a wide discrepancy betweenpractice in different areas. Despite some of the viewscited in the article, it seems unlikely that there will be a

‘one size fits all’ approach. Among the factors which mayneed to be taken into account locally will be the histori-cal division between paediatric and adult services, suit-able venue, poor communication, inadequate multidis-ciplinary team provision, a co-ordinated approach and,perhaps most importantly, the views of the service users– the young people themselves.

In its report ‘Your Local Care 2004’, Diabetes UKpublished the finding that only about half of primarycare trusts in England are effectively prioritising chil-dren’s care. This article shows us the way forward, withthe Table of Recommendations for Transition of Care.We can use the NICE guidelines to persuade local fundholders to establish a first class service for this special group. We must re-engage ‘the lost tribe ofT1D’, thereby potentially reducing the undetected early onset of the devastating complications of T1D inyoung people.

Jane Bramwell, Paediatric Diabetes Nurse Specialist,Royal Gwent Hospital, Newport, South Wales

Establishing a first class service for childrenand adolescents with type 1 diabetesS Greene, A Greene. Changing from the paediatric to the adult service: guidance on the transition of care.Pages 41–45

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