title: Health Care Transition in Young Adults With Type 1 Diabetes: Perspectives of Adult Endocrinologists in the U.S.
abstract: OBJECTIVE
  Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. Our objective was to describe experiences, resources, and barriers reported by a national sample of adult endocrinologists receiving and caring for young adults with type 1 diabetes.
  
  
  METHODS
  We fielded an electronic survey to adult endocrinologists with a valid e-mail address identified through the American Medical Association Physician Masterfile.
  
  
  RESULTS
  We received responses from 536 of 4,214 endocrinologists (response rate 13%); 418 surveys met the eligibility criteria. Respondents (57% male, 79% Caucasian) represented 47 states; 64% had been practicing >10 years and 42% worked at an academic center. Only 36% of respondents reported often/always reviewing pediatric records and 11% reported receiving summaries for transitioning young adults with type 1 diabetes, although >70% felt that these activities were important for patient care. While most respondents reported easy access to diabetes educators (94%) and dietitians (95%), fewer (42%) reported access to mental health professionals, especially in nonacademic settings. Controlling for practice setting and experience, endocrinologists without easy access to mental health professionals were more likely to report barriers to diabetes management for young adults with depression (odds ratio [OR] 5.3; 95% CI 3.4, 8.2), substance abuse (OR 3.5; 95% CI 2.2, 5.6), and eating disorders (OR 2.5; 95% CI 1.6, 3.8).
  
  
  CONCLUSIONS
  Our findings underscore the need for enhanced information transfer between pediatric and adult providers and increased mental health referral access for young adults with diabetes post-transition.
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA katharine.garvey@childrens.harvard.edu.
authors.forename: Katharine C
authors.initials: KC
authors.lastname: Garvey
authors.affiliation: Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA.
authors.forename: Gabriela H
authors.initials: GH
authors.lastname: Telo
authors.affiliation: Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Needleman
authors.affiliation: Clinical Research Program, Boston Children's Hospital, Boston, MA.
authors.forename: Peter
authors.initials: P
authors.lastname: Forbes
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, MA Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000328:Adult; D002648:Child; D003863:Depression; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000628:therapy*; D004704:Endocrinology; D005260:Female; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services; D016017:Odds Ratio; D010372:Pediatrics; D010820:Physicians; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care; D014481:United States; D055815:Young Adult