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Pediatric to Adult Diabetes Care: Transition Planning Checklist

This checklist helps the health care provider, young adult, and family discuss and plan the change from pediatric to  adult health care. While  a variety of events may affect the actual timing when this change occurs, below is  a suggested timeline and topics for review. The young adult, family, and health care provider can obtain  a copy of this  checklist and access many online transition resources at the NDEP website (

  • 1 to 2 years before anticipated transition to new adult care providers
    • Introduce the idea that transition will occur in about 1 year
    • Encourage shared responsibility between the young adult and family for:
      • Making appointments
      • Refilling prescriptions
      • Calling health care providers with questions or problems
      • Making insurance claims
      • Carrying insurance card
      • Reviewing blood sugar results with provider between visits
    • Discuss with teen alone: *
      • Sexual activity and safety
      • How smoking, drugs, and alcohol affect diabetes
      • How depression and anxiety affect diabetes and diabetes care
  • 6 to 12 months before anticipated transition
    • Discuss health insurance coverage and encourage family to review options
      • Assess current health insurance plan and new options, e.g. family plan, college plan, employer plan, and
      • Consider making an appointment with a case manager or social worker
      • Discussion of career choices in relationship to insurance issues
    • Encourage family to gather health information to provide to the adult care team (See Clinical Summary for New Health Care Team at
    • Review health status: diabetes control, retina (eye), kidney and nerve function, oral health, blood pressure, and lipids (cholesterol)
    • Discuss with teen alone: *
      • Sexual activity and safety
      • Smoking status, alcohol, and other drug use
      • Issues of independence, emotional ups and downs, depression, and how to seek help
  • 3 to 6 months before anticipated transition
    • Review the above topics
    • Suggest that the family find out the cost of current medication(s)
    • Provide information about differences between pediatric and adult health systems and what the young adult can expect at first visit
      • Patient’s responsibilities
      • Other possible health care team members such as a registered dietitian or diabetes educator
      • Confidentiality/parental involvement (e.g., HIPAA Privacy Act and parents need permission from young adult to be in exam room, see test results, discuss findings with health care providers), health care proxy
    • Help identify next health care providers if possible or outline process
    • Discuss upcoming changes in living arrangements (e.g., dorms, roommates, and/or living alone)
  • Last few visits
    • Review and remind of above health insurance changes, responsibility for self‐care, and link to online resources at
    • Obtain signature(s) for release for transfer of personal medical information and for pediatric care providers to talk with the new adult health care providers
    • Identify new adult care physician
      • If known – request consult (if possible) and transfer records/acquire hard copy of most recent records
      • If unknown – ask teen to inform your office when known to transfer records and request consult
    • Review self‐care issues and how to live a healthy lifestyle with diabetes
      • Medication schedules
      • Self‐monitoring of blood glucose schedule
      • Importance of managing diabetes ABCs (A1C, blood pressure, cholesterol)
      • Meal planning, carb counting, etc.
      • Physical activity routine and its effects on blood glucose
      • Crisis prevention‐management of hypoglycemia (low blood glucose), hyperglycemia (high blood glucose), and sick days
      • Need for wearing/carrying diabetes identification
      • Care of the feet
      • Oral/dental care
      • Need for vision and eye exams
      • Immunizations
      • Staying current with the latest diabetes care practice and technology
      • Preconception care (preparing for a safe pregnancy and healthy baby)
    • Discuss with teen alone: *
      • Sexual activity and safety
      • Screening and prevention of cervical cancer and sexually transmitted infection
      • Risk taking behaviors, e.g. tobacco/alcohol/drug use
    • Consider ongoing visits with current diabetes educator as part of transition
    • Suggest options for a diabetes “refresher” course

* For more information on addressing psychosocial issues in adolescents, see the HEEADSSS assessment.

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March 2014

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