The transition from pediatric to adult care is an especially challenging time for young adults with diabetes. Hemoglobin A1c (HbA1c) concentrations peak within this age group, and there are high rates of depression and diabetes distress.1 Young adults take on increasing responsibility for their diabetes management while departing the pediatric care environment to which they had been accustomed. A successful transition to adult endocrinology requires thoughtful coordination between the pediatric and adult teams, while also considering the individualized needs of the patient. However, recent studies suggest lingering gaps in transition preparation, barriers to self-care, and a high rate of loss to follow-up.2, 3, 4

To address these concerns, the American Diabetes Association (ADA) published recommendations for best practices for the care of emerging adults with diabetes including transition preparation starting at least 1 year before transfer, age-appropriate diabetes education, referral to adult care providers with interest and expertise in young adult diabetes management, and scheduling assistance with the aim of timing the first visit with an adult care provider within 3 to 4 months of the final pediatric visit.5 The ultimate goal is to provide comprehensive, continuous, and developmentally appropriate diabetes care.

Transition programs that address the unique needs of this population have been carried out in Australia, Canada, Italy, the United Kingdom, and the United States, among others.6, 7, 8, 9, 10 A variety of strategies to improve the coordination have been employed in these programs, including joint pediatric-adult clinic visits, the use of a transition coordinator, sharing a written transfer summary, establishing a specific transfer clinic, as well as several educational interventions (websites, newsletters, resource books, events, etc.). While the outcomes vary by program, these approaches show promise with improved clinic attendance, shorter care gaps, and reduced hospitalizations for diabetic ketoacidosis.4,11,12 Notably, the paucity of randomized trials limits the ability to specify one specific transition program design as a best practice model. Moreover, it is unclear whether a single one-size-fits-all approach to transition care would be successful in every health system. A transition program well suited to one location or health care system may not translate to success in another. Indeed, leveraging local resources and expertise may be critical to the success and long-term viability of transition programs. This suggests that a quality improvement approach with a focus on adapting programs to the local environment may be an effective strategy for diabetes transition care and optimal outcomes.

Here, we describe the development of a novel receivership model young adult diabetes transition program at an academic medical center in the United States. This program, coordinated by a receivership team centered in adult endocrinology, focused on providing evidence-based transition care and incorporated the use of both a transition orientation session and a transition coordinator.13 We were successfully able to adapt the current best practices in transition care based on local resources and culture. Our primary outcome of interest was transition orientation attendance and secondary outcomes include patient satisfaction, care gaps, and 1-year post-transition HbA1c. We believe our results will be instructive for other receivership models of transition care and will open future areas for programmatic improvement to support diabetes transition patients.