- © 2007 Canadian Medical Association or its licensors
The recent CMAJ lead editorial on the challenges of caring for young adults with chronic diseases in the adult health care system is timely.1 Young adults aged 20–29 years with type 1 diabetes are 4 times more likely to die than their peers without diabetes, a rate that is higher than at any other age.2 These deaths are largely due to preventable causes: diabetic ketoacidosis and suicide.3 Failure to adhere to the rigours of daily diabetes care can lead to chronic poor glycemic control and microvascular complications before 40 years of age.
Up to 50% of young patients with diabetes have reported difficulties with the transition to adult health care, and 25%–35% are lost to medical follow-up in the first few years after they move into the adult system.4 Much discordance exists between the developmental tasks of young adults with diabetes (such as moving away from home and starting a career and a family) and the expectations of the systems involved in their care. These patients can feel overwhelmed by the demands of coping with the many changes that occur during the transition to adulthood, and often the result is inadequate self-care and negative attitudes toward their disease and treatment.
In August 2002, the Diabetes Education Resource for Children and Adolescents at the Winnipeg Children's Hospital established a program (Building Connections: The Maestro Project; www.maestroproject.com) that uses a systems navigation model to facilitate the transition from pediatric to adult diabetes care for young adults in Manitoba. The project coordinator maintains contact with the young adults in the program to address any issues that arise during their transition and provides referrals for community services. If we are to reduce morbidity and mortality in young adults with diabetes, new dedicated, flexible systems are required in adult health care to meet the needs of these patients.5