14 Nov 2011
By Melissa Pang
Scheme aims to ensure smooth transition, teaching them to manage condition
IT IS a classic example of what can go wrong when a diabetic defaults on proper treatment.
A 25-year-old woman who has had diabetes since she was in her early teens, has just been told she has retinopathy.
This means the blood vessels in her eyes are damaged as a result of the poor management of her condition, and she could go blind if she does not get medical help.
That she has got to this stage is the result of not having given herself the correct doses of insulin since she was 17, the year she was supposed to start managing her diabetes herself.
As young patients often do not realise the importance of proper diabetes management, the doctors behind the Diabetes Transition Programme want to reach out to them.
The programme, a joint effort between Singapore General Hospital (SGH) and KK Women’s and Children’s Hospital (KKH), aims to teach diabetic teenagers and young adults to manage their condition as they reach adulthood.
SGH’s Department of Endocrinology associate consultant Daphne Gardner said: “Patients who grow up with diabetes often crash-land into an adult setting; they go from a friendly paediatric environment into an adult one.”
Because there is little handover when a child “graduates” from one to the other, many young diabetics feel overwhelmed and discouraged, she said.
This is where the programme comes in.
KKH inducts diabetic children into the programme when they hit the age of 12 or 13. Accompanied by their parents, they learn from the paediatric care team how to take care of themselves and what foods to eat, and also get psychological support.
As the child grows older, the programme evolves with him or her. The programme will address, for instance, teen-specific issues such as sexual health and body image, and how these can be handled in the context of a diabetic’s lifestyle.
When the child is assessed as being ready for a transfer to an adult programme, a personalised transition plan is prepared.
The patient is then referred to the Diabetes Joint Clinic at KKH, where its paediatric team introduces the patient to the SGH team that will take over his or her care through adulthood. Subsequent consultations take place at SGH’s Young Adults with Diabetes Clinic.
The head of KKH’s Endocrinology Service, Associate Professor Fabian Yap, said: “Diabetes is lifelong. If it starts early, you have to navigate through childhood, the teenage years and adolescence, so that’s a lot of changes.”
By collaborating, the doctors in KKH and SGH ensure diabetics are taken through a smooth transition in care from childhood through adult years.
The first joint clinic, the brainchild of Dr Yap and his SGH counterpart Dr Goh Su-Yen, was held in January.
Through this programme, KKH has transferred 35 of its patients to SGH; the transition process for another 115 young patients from KKH has begun.
Child diabetics typically have Type 1 diabetes, which means their body produces little or no insulin, so they need at least three daily injections of this. About seven in 10 child diabetics are Type 1s.
Type 2 diabetes, more common among adults, is a condition in which the body either resists the effects of insulin or does not produce enough.
National serviceman Aw Yong Peng Boon, 21, has attended a five-day diabetes workshop under the programme.
He said: “My parents have been taking care of me since I was diagnosed at age seven. I learnt a lot through the programme, which has taught me to control and manage my diet and condition better.”
At an event to mark World Diabetes Day yesterday, Health Minister Gan Kim Yong stressed the importance of diabetics doing their bit: “While health-care professionals play an instrumental role in good diabetes management... patients themselves play a pivotal role in the lifelong process of diabetes control.”
melpang@sph.com.sg
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