Transition to Adult Diabetes Care: A Description of Practice in the Ontario Pediatric Diabetes Network

Objectives: Individuals living with diabetes often experience gaps in care, poor experiences and acute complications when they transfer from pediatric to adult care. We aimed to describe the structure of diabetes transition care in Ontario and to explore perceptions of barriers to optimal outcomes.

Methods: We conducted a cross-sectional descriptive study of 35 centres in the Pediatric Diabetes Network in Ontario between April and June 2017. We collected survey data about the number of individuals with all diabetes types transferring to adult care, transition practices and providers' perceptions of facilitators of and barriers to optimal transition.

Results: All centres completed the survey. In 2015, 631 of 7,485 (8.4%) individuals with all types of diabetes were transferred to adult care. Of those, 28 of 35 (80%) centres (representing 93% of individuals with all diabetes types) referred at least some individuals to adult endocrinologists. There is a range of centre-transition practices (e.g. structured preparation, workshops, combined visits, transition coordinators). Of the 35 centres, 25 (71%) reported conducting at least 1 initiative to improve transition care. Centres reported challenges related to transition preparation, communication with adult teams, adult programs' abilities to meet the needs of young adults and loss to follow up.

Conclusions: Variations in transition practices present a future opportunity to study the relationship between transition approaches and outcomes. The creation of a provincial data infrastructure that extends beyond transfer to adult care and that facilitates sharing among pediatric and adult centres could foster the development of a learning health system designed to improve transition care and outcomes.