You’ve lived through the middle of the night feedings, the temper tantrums and the back-to-school blues. So why, when someone says the word “teenager,” do some parents visibly wince? 

Fernando Ovalle, right, director of the Multidisciplinary Comprehensive Diabetes Clinic, has helped open the new Adolescent Transition Clinic. The clinic helps ease patients ages 18-24 through the transition of leaving the care of their pediatric endocrinologist for an adult endocrinologist.

But as difficult as the parent-teenager connection can be, another bond also reaches a critical stage during the late teen years — the relationship with their doctor.

Children ages 18 and 19 are on the cusp of leaving the care of their pediatrician, and the teenagers most at risk are those with diseases that require regular management, including diabetes.

The Multidisciplinary Comprehensive Diabetes Clinic, the clinical arm of the Comprehensive Diabetes Center at UAB, has opened the new Adolescent Transition Clinic to help ease patients ages 18-24 through that transition. Adolescents and young adults are seen Thursdays on the first floor of The Kirklin Clinic.

“Adolescents and young adults are a vulnerable group, and their needs differ from children and adults,” says Fernando Ovalle, M.D., clinic director. “They have other issues going on, too — dealing with peer pressure issues, changes in their bodies, psychologically they don’t know who they are yet, what they want to be or what they want to do. Their relationship with their parents becomes strained at many times. It’s sometimes difficult to get along with their peers, their parents or anyone. They want to be liked and part of a group. But often it’s especially hard for those who have a disease and who are to some degree different than the rest.”
Consequently, Ovalle says, it’s one of the worst times for patients to be changing doctors.

“They’ve grown up with their pediatrician. They’ve developed a relationship with them and feel a degree of trust, comfort and respect for them,” he says. “They feel a need to comply with whatever they tell them because it’s somebody who has helped them their whole life. They’re more likely to follow their instructions and do what they are being asked to do because of that relationship.”

Pediatric endocrinologists from Children’s Hospital will bring their patients to the Adolescent Transition Clinic and continue to see their patients for several visits as they integrate them into a new environment. It gives patients an opportunity to learn the new clinic space, get into the system and meet and become comfortable with the new staff.

“It may seem kind of trivial, but it’s a major transition for the patient, and this probably will have a significant impact in keeping them in the system, seeing a physician and getting regular care,” Ovalle says.

Joy Atchison, M.D., associate professor of pediatrics, and Brooks Vaughan, M.D., assistant professor of medicine and pediatrics, are leading the transition effort.

Social worker aids patients
Young adults and adolescents also lose touch with their physicians for another reason: lack of insurance.
Once adolescents graduate from high school many lose their insurance, and they don’t have money to pay for their own insurance or pay for clinic visits. A social worker will be available in the adolescent clinic to help patients with insurance decisions and help find ways to get them care and medications when they don’t have insurance.

“We certainly want to provide them the professional support and counseling we know they need when confronting health and insurance challenges,” Ovalle says.

One-stop shop
“We have been very fortunate to get the support from the Comprehensive Diabetes Center to conduct the adolescent clinic,” Ovalle says. “They’ve received generous support from several sources. A large part of it has been raised by a group of benefactors lead by David Silverstein, Benny LaRussa and Robin Sparks.”

The Crippled Children Foundation also awarded the clinic a grant to help subsidize the work of the diabetes educator and the social worker.

“This is a one-stop shop for teenagers, adolescents and adults,” Ovalle says. “Our patients have access to four or five different specialists during their visit, including a nutritionist/certified diabetes educator, endocrinologist, ophthalmologist, orthopedic surgeon and a podiatrist. We are able to bring together all of the different disciplines typically involved in the care of diabetics in a single space and have our patients see the specialists they need to see in a single day.”

Call 801-7450 for information on the Adolescent Transition Clinic or to schedule an appointment. Visit diabetes.dom.uab.edu for more on the Comprehensive Diabetes Center.