P-390: Falling off the “Transition cliff”: a doctor–patient case report of type 1 diabetes transition failure in Kenya
B S OchiengAbstract
Introduction
Transition from pediatric to adult care in Type 1 Diabetes (T1D) is a vulnerable period, particularly in low-resource settings where structured transition systems are lacking.
Objectives
To describe the clinical and psychosocial impact of unstructured transition from pediatric to adult diabetes care from a dual doctor–patient perspective.
Methods
This auto-ethnographic case report describes a Kenyan Medical Officer with over 20 years of lived experience with T1D. Personal clinical data and retrospective analysis were used to examine the transition experience following discharge from a donor-supported pediatric diabetes program.
Results
Transition occurred without structured preparation, counselling, or referral to adult care services and coincided with a period of financial and professional instability. This resulted in clinical deterioration, with HbA1c increasing from 5.6% to 7.4% within months. Loss of subsidized insulin led to rationing and disrupted access to care. The patient experienced significant diabetes distress, burnout and social isolation. Despite high health literacy and medical training, there was increased risk of loss to follow-up and reduced self-management capacity.
Conclusions
Unstructured transition represents a critical gap in T1D care, with significant clinical and psychosocial consequences even among medically trained individuals. Lived experience offers important insights to inform development of context-appropriate transition strategies in similar settings.