Transition from paediatric to adult healthcare : effectiveness of the Westmead Diabetes Transition Service : (the TALENT study)

Abstract

The number of young adults diagnosed with type 1 diabetes is increasing globally and is the most common childhood non-communicable disease after asthma. Type 1 diabetes is a complex condition which requires 24- hour vigilance of blood glucose levels, insulin administration, and food and exercise. Individuals need to be well informed in self-management skills to prevent or respond to acute diabetes crises. In Australia, transition from paediatric to adult health care occurs at the end of schooling or between 16-18 years of age. Given the large numbers in paediatric care, young adults with type 1 diabetes have featured significantly in the transition literature; however, there are limited reports of successful interventions in adult health care. The aim of this multi-method study is to evaluate the feasibility, acceptability, effectiveness and sustainability of a structured intervention (WDTS) model in improving diabetes health outcomes and sick-day management tailored for YWD following their transition from paediatric to adult health care. The thesis aims to contribute to the knowledge on the effects of sustainable interventions through evaluating the key components of the Westmead Diabetes Transition Service model. This model is aligned with the Care Transition Framework that provided the theoretical underpinnings for the study. This comprehensive and long-term evaluation of the Westmead Diabetes Transition Service model of care provided evidence that age-appropriate interventions can improve the health outcomes of young adults with type 1 diabetes following transition to adult care. More importantly, glycaemic control alone was an imperfect measure, as it failed to "tell the whole story" of day-to-day diabetes self-care and the value of continued engagement with a multidisciplinary transition service to prevent deterioration in diabetes management following transition. The importance of developing trusting relationships between adult providers and young adults with type 1 diabetes is critical to prevent loss to medical follow-up and reduce the risk of acute diabetes crises. The utilisation of phone support promoted self-efficacy in selfmanagement of sick days for young adults with type 1 diabetes; hence, development of transition strategies should take into account changing technology and the use of telematics among young adults. Diabetes control following transition can be maintained with regular attendance at followup. However, if young adults with type 1 diabetes are to meet the recommended levels of glycaemic control, further research into psychological and behavioural interventions to promote self-efficacy and address diabetes-related distress earlier in adolescence and prior to transition are likely to be required to improve diabetes control at entry to adult services.

Date of Award	2019
Original language	English