The All Wales Standards for People with Diabetes Moving from Paediatric to Adult Services within NHS Wales have been developed as part of the recommendations given by Welsh Government.
Around 96 per cent of children and young people with diabetes in Wales have Type 1 diabetes. They are treated in specialist paediatric diabetes units, there are 14 of these in Wales. It is expected that they will then transfer from the paediatric services to adult services when they become adults.
There’s a large amount evidence which demonstrates that poor transition from paediatric to adult services have long term effects, including disengagement with healthcare services and heightened risk of list-limiting complications and poor mental health.
The first National Diabetes Transition Audit’s key findings indicate that young adults have fewer annual hbA1c measurements with higher average hbA1c scores. The findings also indicate that other health indicators; e.g cholesterol and blood pressure, also deteriorate post-transition.
A planned transition from paediatrics to adult services between the ages of 16 to 19 are most likely to benefit from regular engagement with healthcare services. The benefits of positive experiences when moving from paediatric to adult services are documented in terms of improved clinical outcomes and quality of life.
Due to many young people not having a positive experience when they move to adult services, which has a negative impact on management of their diabetes, a standard has been developed to support adult and paediatric teams to work together for a smooth transition process.
This involves joint working between the ages of 16 and 19 and extends the process to start from around age 14 and continuing until the age of 25, creating a young adult service that caters for the specific needs of this age group.
The standard has been developed as the National Transition Diabetes Audit shows that hospital admissions for diabetic ketoacidosis (DKA) peak between the ages of 16 and 20. These admissions practically ride after the move from paediatric to adult services.
This has an impact on the NHS overall due to the implications for service planning and the substantial cost. This peak could be prevented with improvements to the process of moving to adult services.
The broader changes to a young person’s life should also be taken into account during the care transition period. As well as dealing with diabetes, young people also have to deal with the possibility of experiencing other life changes such as:
These changes can have an impact on daily life and routines which will impact on diabetes management.