Implementation of a Diabetes Transition of Care Program

Jeanne M. Little, DNP, CPNP-AC/PC; Janice A. Odiaga, DNP, CPNP-PC; Carla Z. Minutti, MD


J Pediatr Health Care. 2017;31(2):215-221. 

In This Article

Setting and Target Population

The setting was a pediatric endocrine subspecialty clinic located within a nonprofit, 664-bed Midwest urban academic medical center serving a diverse ethnic and socioeconomic population. In addition to the main campus, there are two offsite satellite clinics where pediatric providers evaluate patients with Type 1 diabetes monthly. The academic medical center has a large adult diabetes clinic housed within the same campus as the pediatric diabetes clinic, and they communicate with each other via a shared electronic medical record (EMR).

Two pediatric endocrinologists lead the pediatric diabetes clinic, serving approximately 75 patients of all ages with Type 1 diabetes. Patients eligible to begin transition planning were 14 years of age or older with a diagnosis of Type 1 diabetes. Exclusion criteria included youth with Type 1 diabetes with developmental disabilities, steroid-induced diabetes, and diabetes acquired from underlying conditions (e.g., cystic fibrosis).