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Transitioning to adult care in youth-onset diabetes: a scoping review of socio-ecological factors in youth-onset type 2 diabetes compared to type 1 diabetes

BMC Public Health volume 25, Article number: 1784 (2025) Cite this article

Abstract

Background

Multiple socio-cultural and personal factors influence the transition from pediatric to adult-centered diabetes care in youth-onset type 1 diabetes (Y-T1D), but few data exist in youth-onset type 2 diabetes (Y-T2D). We determined the scope of the literature on socio-ecological factors associated with transitioning to adult care in Y-T2D compared with Y- T1D to identify facilitators, barriers, and knowledge gaps in Y-T2D.

Method

We conducted a global scoping review using the Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR) guidelines. Eligible articles were peer-reviewed experimental and quasi-experimental articles published between January 1990 and September 2022, with no language restrictions.

Results

In 104 articles that reported on transitioning to adult care, 88% were in Y-T1D, 6% compared Y-T1D and Y-T2D, 2% reported in Y-T2D only, and 4% reported on youth-onset diabetes diagnosis. The proportion of articles that reported on socio-ecological domains were similar in Y-T1D compared to articles that included Y-T2D. Identified challenges associated with the transitioning period in Y-T2D were societal (structural bias, poverty, inadequate social support), health cultural (limited access to adult health-care providers), psychological (feelings of anxiety and fear of transition), and behavioral (difficulty with medication adherence). The transition period was associated with worsening glycemic control in both groups.

Conclusions

Y-T2D face multiple challenges across socio-ecological domains during the transition to adult-centered diabetes care. However, only 8% of studies on transitioning factors included Y-T2D and additional research is needed to develop dynamic and robust transition programs in Y-T2D.

Scoping review registration

Protocol was registered with Open Science Framework, April 4, 2022. https://osf.io/k2pwc.

Peer Review reports

Introduction

Youth-onset type 1 (Y-T1D) and youth-onset type 2 diabetes (Y-T2D) are among the most common chronic conditions of childhood. The annual incidence of Y-T1D is 22 per 100,000 and 18 per 100,000 in Y-T2D with rates increasing worldwide [1,2,3]. Contemporary treatment regimens for both types of youth-onset diabetes—including novel pharmacologic agents and device-assisted technologies—dramatically optimized diabetes care and markedly improved quality of life [4]. However, for many youths, there are persistent challenges in accessing these treatments. Further, diabetes-related distress and complications are ever-present realities that contribute to disease-related burdens during adolescence [5]. Socio-economic (for example, food and housing insecurity) and personal challenges (including depression and mood conditions) related to diabetes care often begin during childhood and may peak during adolescence [6]. Moreover, diabetes burdens are magnified by the uncertainty and anxiety that come with emerging into adulthood. The normative emerging adulthood period—which may begin as early as 13 years of age and continue through 25 years of age —marks a major shift to autonomy in thought, self-identification, and behaviors [7]. This period is critical for reinforcing diabetes-related self-management strategies aimed at optimizing long-term health. Structured clinical programs are essential for supporting adolescents during this developmental period to promote autonomy, optimize health outcomes and healthcare utilization, and promote positive health system experiences [8, 9]. However, the transition period from pediatric to adult care diabetes services has been strongly linked to poor outcomes and worsening diabetes control in Y-T1D and there are scarce data in Y-T2D [10, 11].

Factors that promote or impede the transitioning of diabetes care in Y-T1D are well described and include socio-cultural, psychological, and structural ecological factors (such as access to health care, financial burdens, and gender biases) [11]. Psychological factors, including mood disorders and community relationships are established challenges that influence transitioning of care in Y-T1D [12]. Emerging Y-T1D must balance increasing financial and social independence with burdensome diabetes self-management tasks including carbohydrate counting, insulin pump or injection management, and multiple daily blood glucose monitoring. Successful transition programs in Y-T1D employ coordinated, purposeful, and planned multistep processes to facilitate uninterrupted care delivery to optimize glycemic control [13].

The barriers and facilitators for successful transitioning to adult care in Y-T2D are not as well-established or understood. Factors promoting healthy transitioning in Y-T2D may be distinct from those reported in Y-T1D because the social, personal, and diabetes care obstacles may differ between the two conditions. In contrast to Y-T1D, self-management in Y-T2D may include an array of treatment strategies ranging from diet and lifestyle interventions to daily oral medications and/ or weekly incretin analogues to frequent insulin injections and continuous glucose monitoring. Moreover, novel anti-diabetes agents, such as sodium glucose transporter-2 inhibitors and once weekly glucagon-like 1 receptor agonists, increase the suite and choice of diabetes agents available to Y-T2D [14]. Adherence to non-insulin medications may be challenging. Contemporary medicines may require dose escalation over weeks to months and understanding which medications are covered by health insurance can be daunting. Navigating prescription drug and device management and social determinants of health could pose additional barriers during transition for Y-T2D [15], but whether these factors have been systematically evaluated remains unanswered.

Therefore, to comprehensively compare factors associated with transitioning care in Y-T1D and Y-T2D, we used the socio-ecological framework a conceptual method of describing the relationship between individual, community, and societal level influences [16]. This model facilitates a broad map of the literature to identify known mediators and intervention areas for future research [17,18,19]. Our objectives were to determine the scope of the literature on (1) factors within the socio-ecological framework (societal, community/ relationship, individual/ biological) associated with transitioning to adult care in Y-T2D compared with Y- T1D, (2) facilitators and barriers to transitioning to adult care in Y-T2D, and (3) to identify knowledge gaps related to transitioning to adult care in Y-T2D.

Materials and methods

Design and search strategy

A scoping review was conducted to map the state of the literature on transitioning care in youth-onset diabetes and to identify the main sources and types of evidence available. The detailed protocol, including search terms that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR) and JBI methodological framework and the search strategy was published [17]. The proposed scoping review protocol was registered with Open Science Framework on 4 April 2022 (OSF Registries| Socio-ecological Factors in Transitioning from Youth to Adult Diabetes Care: A Scoping Review Protocol). In summary, we completed a systematic search of the Embase, PubMed, and Cumulative Index of Nursing and Allied Health (CINAHL), PsycINFO and Scopus databases of experimental and quasi-experimental studies published. As described in the protocol, we used the following main terms: diabetes, youth and young adults, sociologic, psychological, and socioecological factors [17].

Eligibility criteria for article selection included a main outcome related to transitioning from youth to adult diabetes care and a publication period between from January 1,1990 to September 30, 2022. Initial abstract screening inclusion criteria were children/ young adults age 0–25 years with a diagnosis of Y-T2D and Y-T1D. After study screening, the inclusion criteria for the protocol was amended to include youth-onset diabetes (either Y-T1D, Y-T2D, or unspecified) and to remove the age criteria. These changes were made because four studies referenced youth-onset diabetes but did not specifically define Y-T1D or Y-T2D. In addition, several studies did not report age or included both young and older adults. These changes were justified because of the broad objectives for this scoping review and the goal of capturing all studies related to transitioning to adult care, regardless of age. Peer-reviewed, original experimental and quasi-experimental study designs were included, and there was no imposed race, ethnicity, country, or language restrictions to facilitate a broad global search [17]. Non-English printed articles were translated to English by a certified translator (NIH Library) for review. We included original articles only. Systematic or narrative reviews, commentaries, experiential articles, abstracts, anecdotal reports, and unpublished articles were excluded from this scoping review [17].

Data extraction and data synthesis

The data extraction plan and outcomes were developed a priori [17]. Extracted elements from each study included: study design, year of publication, country of study, characteristics of the sample, and variables studied. Data items associated with transitioning from pediatric to adult diabetes care were categorized by socio-ecological level: (1) societal/ social determinants of health (structural bias, food insecurity, poverty, medical infrastructure and access to multidisciplinary care), (2) relationship/ community factors (psychological and behavioral factors including resiliency, anxiety, depression, diabetes management and medication adherence support, attitudes towards healthcare, health cultural attitudes, social support systems, or adverse childhood events) and (3) individual characteristics (biological sex, age, race/ethnicity, hemoglobin A1c (HbA1c), self-management behaviors). Citations were imported into Covidence (Melbourne, Australia) for title, abstract and full text screening. This was a descriptive scoping review, and no formal statistical hypothesis testing was performed. Three review authors (SD, AU, and TC) independently conducted the data extraction from each paper. Any discrepancies or uncertainties were resolved through discussion with the lead investigator STC after piloting the data charting process. Data from individual studies were extracted and collated in the Research Electronic Data Capture (REDCap) database. Studies were grouped by population: Y-T1D, Y-T2D, and Both/ Unspecified. Descriptive statistics were reported percentages, unless otherwise stated. Statistical analyses were performed in STATA (version 18.0, Stata Corp, College Station, TX, USA).

Results

Of the 10,466 articles identified, 332 articles were assessed for eligibility (Fig. 1). Of the 332 articles assessed for eligibility, 25 articles were reviews: two were systemic reviews, and 23 were narrative reviews. Although four of the narrative reviews mentioned Y-T2D in addition to Y-T1D, none of the reviews distinguished between factors influencing transitioning in Y-T1D and Y-T2D [13, 20,21,22]. One hundred and four articles were included in the scoping review, of which three were translated to English [23,24,25]. Only two studies were published before 2000 and the majority of studies that included Y-T2D were published after 2010. Table 1 shows the study design and population demographics of the 104 included studies. Most articles published (88%, n = 91) reported on transitioning of care in Y-T1D, 2% (n = 2) investigated transitioning in a Y-T2D cohort only, 6% (n = 7) compared Y-T1D and Y-T2D populations, and 4% (n = 4) did not specify the diagnosis type (Fig. 2; Table 2). Two-thirds of articles were conducted in a healthcare setting. Table 1 illustrates the study design and demographics grouped by population; 63% percent of studies reported on participants in North America with 52% percent in the United States of America (Table 1, Supplemental Table 1). Many participants were female and white ethnicity (Table 1), but only 43% of studies reported demographic data on race/ethnicity. 50% of studies used quantitative study design. In Y-T1D, there were: two randomized controlled, two non-randomized controlled, ten cohort, seventeen cross-sectional, fifteen longitudinal, thiry-seven qualitative, and eight mixed methods design. In studies that included Y-T2D/ Both: there were no randomized trials, two cohort, one cross-sectional, three longitudinal, three qualitative, and two mixed methods design.

Fig. 1
figure 1

PRISMA-ScR flow diagram

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Table 1 Population characteristics and socio-ecological factors reported in studies examining transitioning of diabetes care in youth with type 1 (Y-T1D) and type 2 (Y-T2D) diabetes
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Fig. 2
figure 2

Socio-ecological Factors reported in studies of transitioning to adult diabetes care. (A) Bar graph showing percent of studies that reported social determinants of health (SDOH), health cultural factors, psychological factors, behavioral factors, and biological factors among all by population, Both/ Unspecified youth diabetes (purple), youth-onset type 2 diabetes (blue), and youth-onset type 1 diabetes (orange). (B) Reported barriers to transitioning to adult care conceptualized within the socio-ecological model. The model highlights the interrelationship between each level (circle) [91, 94,95,96, 98, 100]

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Table 2 Demographic, study design, and main results for the studies that included an assessment of transitioning to diabetes care in youth-onset type 2 diabetes
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Transition-related factors characterized by socio-ecological domains of influence

The number of studies categorized by socio-ecological factor collected in Y-T2D and Y-T1D is illustrated in Fig. 2A and reported in Supplemental Table 1.

Societal factors

Most studies (82%) analyzed the association of transition care with social determinants of health (Fig. 2A). Specific factors detailed in the studies differed by population, and there was no universal societal factor collected across all studies. In Y-T1D studies, social determinants of health reported included: access to healthcare [23, 26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51], economic stability [23, 25, 30, 47, 52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68], education and policies [23, 25, 26, 30, 32, 35, 37, 40, 42, 44, 46,47,48, 50, 51, 53, 55,56,57,58,59,60, 62,63,64,65, 68,69,70,71,72,73,74,75,76,77,78,79], neighborhood and built environment [28, 34, 39, 42, 48, 53, 55, 56, 58,59,60, 62,63,64, 69, 70, 74, 79,80,81,82], social and community support [23, 25,26,27,28,29,30, 35, 38, 41, 43, 44, 47, 49, 52,53,54,55, 63,64,65,66,67,68, 70, 71, 73, 74, 77,78,79,80,81,82,83,84,85,86,87,88,89,90], food insecurity [63], and poverty [23, 32, 39, 54, 63]. No studies in Y-T1D investigated structural bias. In Y-T2D/Both studies, two thirds reported on access to healthcare [91,92,93,94,95,96,97,98,99], structural bias [91], poverty [98], education and policy [94, 96], economic stability [91, 94, 96, 98], social and community support [91, 93, 95, 97, 100, 101], and neighborhood and built environment [91, 94, 98]. No articles reported on the impact of food insecurity on transitioning to adult diabetes care in Y-T2D.

Community/ relationship factors

Health cultural

Reporting of health cultural factors was common and collected in 68% of all studies (Fig. 2). Health cultural factors commonly collected in Y-T1D included: attitudes towards health care [26, 27, 30, 34,35,36,37, 39, 45, 47, 51, 55, 56, 59, 61, 63, 68, 72, 73, 77, 79, 82, 83, 87, 102,103,104,105,106], health cultural attitudes [26, 28, 30, 32, 34,35,36, 41, 43, 46, 47, 55, 56, 58, 59, 63,64,65, 68, 73, 81,82,83, 86, 89, 102, 104,105,106,107,108,109], community or provider diabetes care practices [26, 30, 31, 35, 36, 38, 43, 46, 48, 49, 51, 61, 64, 72, 77, 79, 82,83,84, 86, 89, 104,105,106, 108, 110], and multi-disciplinary clinics [39, 45, 64, 73, 83, 86, 104, 106, 108, 110]. Eleven studies reported on at least one health cultural factor in Y-T2D/ Both; attitudes towards health care [91, 93,94,95, 101], health cultural attitudes [91, 93,94,95, 97, 100], community or provider diabetes care practices [93, 95, 97], and multi-disciplinary clinics [93, 95,96,97]. The presence of multi-disciplinary clinic and easy access to adult healthcare provider facilitated transitioning to adult-centered care [91].

Psychological

Data documenting mood symptoms, anxiety or depressive disorders were reported in 59% of all studies (Fig. 2A). In Y-T1D, one study examined the impact of early childhood adversity [84], one on post-traumatic stress disorder [31], and multiple assessed disordered eating behaviors [28, 31, 32, 40, 109,110,111,112,113], depressive symptoms [24, 25, 27, 28, 31, 32, 36, 38, 40, 44, 58, 61, 62, 69, 81, 110,111,112,113,114,115], and anxiety-related symptoms [24, 28, 31, 32, 40, 44, 61, 81, 112, 113, 116]. In Y-T2D, few studies assessed mood symptoms (depression and anxiety [91, 94, 100]) and stress [97]. We did not find any studies that collected data on eating disorders, early childhood adverse events, or post-traumatic stress disorder in Y-T2D.

Behavioral

Eighty-four studies (Fig. 2) collected data on behavioral factors. In Y-T1D, studies included data on self-management and medication adherence support [24, 26,27,28,29, 31, 33,34,35,36, 38, 41,42,43, 46, 47, 52, 53, 56, 57, 59, 62,63,64,65,66,67,68,69,70, 72,73,74, 76, 78,79,80,81, 83,84,85,86,87, 90, 102, 105,106,107,108,109, 111, 116,117,118,119]. Specific behaviors that impeded outcomes included substance abuse, neglect, use of technologies, transition readiness, and medication dosing. Diabetes self-management strategies were reported on a range of activities, including dietary choices, physical activity, blood glucose monitoring, and medication management. Nine Y-T2D/ Both studies reported on behavioral factors including information on scheduling and attending appointments, self-management strategies, blood glucose monitoring, medication management, and goal setting [91, 93, 95,96,97, 100, 101, 120, 121]. Additional behaviors that were found to impede outcomes were social isolation [91], risky behaviors (e.g., substance use, previous incarceration) [120], and lack of chore engagement [101]. We did not find any studies that reported on dietary choices and physical activity in Y-T2D during transition.

Individual/ biological factors

Metabolic biomarkers (body mass index, HBA1c, weight, fructosamine, blood pressure, cholesterol, urine albumin, serum bicarbonate, and ketones) were collected in 58 studies (58% Y-T1D, 50% Y-T2D, 36% of both). No studies examined fasting glucose or fasting insulin concentrations.

Facilitators and barriers to transitioning care in Y-T2D [96]

Figure 2B illustrates cited barriers experienced in Y-T2D/ Both across the socio-ecological domains. Table 2 details the main results for the studies that included Y-T2D by diagnosis grouping. Most studies evaluated the outcomes of transitioning to adult care while only 2 studies assessed the effect of formulated transition programs [101, 122]. The association of transitioning to adult care was inconsistently related to worsening glycemic control and poor outcomes. For example, the transitioning period was related to 4-fold higher odds of HbA1c greater than 9% in Y-T2D in the SEARCH for Diabetes in Youth Cohort [92]. Though, the transition period was not related to increased diabetes-related hospitalizations in the United States [98]. In contrast, a robust prospective cohort study in Canada described higher rates of hospitalizations and fewer medical visits in the transitioning period in Y-T2D compared to Y-T1D [94]. A retrospective analysis from Australia found poor diabetes-related outcomes related to fewer medical visits [120]. Frequent HbA1c testing in Y-T2D was not a predictor of glycemic outcomes or microvascular complications compared to Y-T1D [123].

Feelings of anxiety, depression, and low self-worth were prevalent among transitioning Y-T2D and Y-T1D, although there was a small sample size of Y-T2D in these studies [91, 95, 100]. Y-T2D reported economic challenges, life transition, stigma, a sense of guilt, and fear of being judged by others as impediments to transitioning to adult-centered care [91]. Other factors related to poor diabetes outcomes in Y-T2D were structural bias, poverty, economic instability, access to quality healthcare, neighborhood and built environment, and social and community support [91, 94, 96, 98].

Four studies investigated the factors contributing to resiliency and mitigating strategies Y-T2D/ Both [93, 94, 96, 101]. Routine performance of household chores [101], easy access to clinics located in close proximity to the pediatric clinic, purposeful developmental age-appropriate diabetes education, older age during transfer to adult care [93], an internet-based program [96], the presence of a multi-disciplinary clinic, and easy access to adult healthcare providers [91] were identified facilitators of transition care. Difficulty establishing rapport with patients, abrupt transition to a new clinic, long waiting period for appointments, and relocation to the new environment were barriers to transitioning to adult care [94, 96]. The presence of a multi-disciplinary clinic and easy access to adult healthcare providers facilitated transitioning to adult-centered care [91].

Discussion

This scoping review provided a global assessment of socio-ecological factors associated with transitioning to adult-centered diabetes care in Y-T2D compared to Y-T1D. The review confirmed that the transitioning period from pediatric to adult diabetes care is associated with difficulties in diabetes self-management and social barriers to care for both Y-T2D and Y-T1D. Our scoping review supports the American Diabetes Association (ADA) position statement of transitioning care (2011) and the 2025 ADA Standards of Care recommending effective systems-based and translatable transition processes for all youth with diabetes [4, 124]. However, only 8% of studies examined socio-ecological factors in Y-T2D only group, and the evidence quality in Y-T2D studies was predominantly from observational studies with no rigorous randomized studies evaluating transitioning strategies or programs in Y-T2D.

This comprehensive scoping review was the first step towards rigorously mapping the complex transitioning literature on social, economic, psychological, cultural, behavioral, and biological domains of influence. Significant knowledge gaps in understanding the broad range of socio-ecological factors affecting the transition to adult-centered care remain. Based on this scoping review, reporting on the effects of social determinants of health and behavioral self-management factors was common in both Y-T1D and Y-T2D, but fewer studies investigated community and relationship factors (Supplemental Table 1). Fewer than half of studies in Y-T2D reported on psychological factors, which contrasts with data in Y-T1D. Therefore, additional studies are needed to examine transition-related outcomes and transition strategies, especially in psychological domains, that can support the development of effective transitioning programs in Y-T2D.

Understanding the unique barriers and facilitators of transitioning to adult diabetes care in Y-T2D compared to Y-T1D is critical because the disease burdens, complications, correlates, and risk factors markedly differ between the two conditions [125]. In Y-T2D, diabetes-related complications are present at diagnosis in up to 25% of youth, and rates of complications continue to rise, especially during the emerging adult years [126, 127]. Since the period between adolescence and young adulthood is marked by physiological, socio-emotional, and behavioral alterations such as experimentation, risky behaviors, mood changes, feelings of vulnerability, and invincibility [128, 129], designing effective transition programs should include individualized, dynamic, and iterative programs that can accommodate the changing needs of adolescents with Y-T2D [9, 130]. This review showcased poor diabetes-related outcomes in both Y-T1D and Y-T2D. Y-T2D had greater than 3-fold higher odds of worsening glycemia and lack of insurance [92]. Higher rates of diabetes hospitalization and HbA1c were observed in Y-T2D [92, 94, 120], though not in all studies [98]. Disparate results among studies could be due to differences in the natural history of Y-T1D and Y-T2D and/or confounded by the small number of research studies evaluating a limited number of Y-T2D.

No experimental studies examined causative factors associated with poor transition outcomes in Y-T2D. Review of the limited observational studies in the literature suggested that socio-ecological factors across all domains may exacerbate the burdens among Y-T2D who are disproportionately impacted from underserved communities [6]. Social barriers to independence in diabetes self-care may include poverty, restricted access to diabetes-related medications and technologies, structural bias, food insecurity, and difficulty navigating public health insurance [15, 131]. However, a systematic analysis was not possible because the study methodology and transitioning programs were varied in scope, by country and by institution. Inequalities in Y-T2D disease burden may be magnified during the transition from pediatric to adult care, but more data are needed to quantify the factors mediating these disparities.

Despite these study limitations, we identified a range of facilitators and barriers that should be considered when designing diabetes transition modules for Y-T2D. Mood-related symptoms were prominently reported across studies. Anxiety-related symptoms punctuated the transition period and sometimes co-existed with other feelings of stigmatization and worry about socio-economic burdens. Recent analysis in emerging adults from the TODAY iCount ancillary study support the importance of mindfulness and health cultural impacts in Y-T2D, although these studies were not included in this scoping review because they did not include a transition care focus. Diabetes self-efficacy, beliefs about medication, diabetes distress, and social factors were key determinants of medication adherence and glycemic control in Y-T2D [132,133,134]. Additional studies are also needed to characterize the scope of psychological influences on emerging adults with Y-T2D, especially since we did not identify any articles describing the impact of adverse childhood experiences or other comorbidities (including eating disorders) on health outcomes during the transition period.

Attitudes towards healthcare, the availability of community or private diabetes care practices, and multi-disciplinary clinics also influenced engagement in Y-T2D. Though programmatic data is limited, programs that recognized cultural influences on health behaviors and healthcare utilization (providing telehealth or programs that encouraged early and open dialogue with healthcare providers and adolescents) were feasible and successful in Y-T2D [93, 94, 96, 101]. Intentional efforts to promote transparency and knowledge dissemination to adolescents and emerging adults could improve healthcare access, enhance patient-provider communication, and promote culturally competent diabetes self-management strategies among diverse populations, but requires further investigation. This is an active area of ongoing research, and two studies have recently been published examining health care utilization in Y-T1D [135] and illness experiences in Y-T2D during the transitioning period [136]. Sadness, ambivalence, and fear of the adult environment were consistently reported as important barriers to transitioning to adult care [136].

Limitations

Studies in Y-T2D were limited because of their relatively small sample size, low power, and diverse study designs that precluded systematic comparison between the two groups. The broad types of studies assessed and few data on transitioning in Y-T2D precluded a comprehensive literature appraisal to determine the direction of associations or extraction of effect size estimates. Finally, to increase analytical rigor, we designed this study to include published peer-reviewed articles only. However, we acknowledge that our scoping review was limited because quality assessments of study designs were not performed, and excluding non-peer-reviewed literature increased the risk of selection bias.

Conclusion

Transitioning to adult-centered diabetes care is associated with multiple challenges across the socio-ecological domains in Y-T2D, but there is insufficient data to support robust design of Y-T2D transitioning programs. The scope of psychological and behavioral factors that influence transitioning to adult care in Y-T2D is poorly defined. Social determinants of health, the presence of social stigma, mood-related symptoms, and concerns about healthcare system were reported barriers to care in Y-T2D. Additional research is needed to identify culturally sensitive and structural factors to guide health policy and transition programs for successful healthcare continuity in Y-T2D. Targeted interventions that support systems navigation, health culture relationships, reduce social stigma, and address mental-health symptoms are needed to achieve successful transitioning to adult care.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. All articles included in this review are available in the supplementary table.

References

  1. Perng W, et al. Youth-onset type 2 diabetes: the epidemiology of an awakening epidemic. Diabetes Care. 2023;46(3):490–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Wagenknecht LE, et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, 2002-18: results from the population-based SEARCH for diabetes in youth study. Lancet Diabetes Endocrinol. 2023.

  3. Imperatore G, et al. Projections of type 1 and type 2 diabetes burden in the U.S. Population aged < 20 years through 2050: dynamic modeling of incidence, mortality, and Population growth. Diabetes Care. 2012;35(12):2515–20.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Committee ADAPP. 14. Children and adolescents: standards of care in Diabetes—2025. Diabetes Care. 2024;48(Supplement1):S283–305.

    Google Scholar 

  5. Li Y, Guo C, Cao Y. Secular incidence trends and effect of population aging on mortality due to type 1 and type 2 diabetes mellitus in China from 1990 to 2019: findings from the global burden of disease study 2019. BMJ Open Diabetes Res Care. 2021;9(2).

  6. Gaskin DJ, et al. Disparities in diabetes: the nexus of race, poverty, and place. Am J Public Health. 2014;104(11):2147–55.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Arain M, et al. Maturation of the adolescent brain. Neuropsychiatr Dis Treat. 2013;9:449–61.

    PubMed  PubMed Central  Google Scholar 

  8. White PH et al. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2018;142(5).

  9. Malik FS, et al. Incorporating the six core elements of health care transition in type 1 diabetes care for emerging adults. Endocrinol Metab Clin North Am. 2024;53(1):53–65.

    Article  PubMed  Google Scholar 

  10. Campbell F, et al. Transition of care for adolescents from paediatric services to adult health services. Cochrane Database Syst Rev. 2016;4(4):Cd009794.

    PubMed  Google Scholar 

  11. Peters A, Laffel L, and G. American Diabetes Association Transitions Working. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care. 2011;34(11):2477-85.

  12. Monaghan M, Baumann K. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care. Res Rep Endocr Disord. 2016;6:31–40.

    PubMed  PubMed Central  Google Scholar 

  13. Lewis K, Hermayer K. All grown up: moving from pediatric to adult diabetes care. Am J Med Sci. 2013;345(4):278–83.

    Article  PubMed  Google Scholar 

  14. Chung ST, et al. Reevaluating first-line therapies in youth-onset type 2 diabetes. J Clin Endocrinol Metab. 2024;109(2):e870–2.

    Article  PubMed  Google Scholar 

  15. Hill JO, et al. Scientific statement: socioecological determinants of prediabetes and type 2 diabetes. Diabetes Care. 2013;36(8):2430–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Schwartz LA, et al. A social-ecological model of readiness for transition to adult-oriented care for adolescents and young adults with chronic health conditions. Child Care Health Dev. 2011;37(6):883–95.

    Article  CAS  PubMed  Google Scholar 

  17. Ude AO, et al. Transitioning care in youth-onset type 1 and type 2 diabetes: a scoping review protocol using the socio-ecological model framework. BMJ Open. 2022;12(10):e064186.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Graif C, Meurer J, Fontana M. An ecological model to frame the delivery of pediatric preventive care. Pediatrics. 2021;148(Suppl 1):s13–20.

    Article  PubMed  Google Scholar 

  19. Kilanowski JF. Breadth of the socio-ecological model. J Agromedicine. 2017;22(4):295–7.

    PubMed  Google Scholar 

  20. Jones SE, Hamilton S. The missing link: paediatric to adult transition in diabetes services. Br J Nurs. 2008;17(13):842–7.

    Article  PubMed  Google Scholar 

  21. McGill M. How do we organize smooth, effective transfer from paediatric to adult diabetes care? Horm Res. 2002;57(Suppl 1):66–8.

    CAS  PubMed  Google Scholar 

  22. Lee YA. Diabetes care for emerging adults: transition from pediatric to adult diabetes care systems. Ann Pediatr Endocrinol Metab. 2013;18(3):106–10.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liu F, et al. Status of social avoidance and distress in emerging adults with type 1 diabetes mellitus and its association with self-management and glycemic control. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020;45(7):834–9.

    PubMed  Google Scholar 

  24. Halldórsdóttir H, et al. Clinical status and treatment adherence of young adults with type one diabetes mellitus following transition to adult health care. Laeknabladid. 2009;95(11):755–61.

    PubMed  Google Scholar 

  25. Weyhreter H. What becomes of children with diabetes mellitus in adulthood? Diab Stoffw. 1996;5:56–62.

    Google Scholar 

  26. Addala A, et al. The interplay of type 1 diabetes and weight management: a qualitative study exploring thematic progression from adolescence to young adulthood. Pediatr Diabetes. 2019;20(7):974–85.

    Article  PubMed  Google Scholar 

  27. Brady PJ, Song HJ, Butler J 3. Using an expert panel to develop social support program sequencing for young adults with type 1 diabetes. Health Promot Pract. 2017;18(6):789–97.

    Article  PubMed  Google Scholar 

  28. Castensøe-Seidenfaden P, et al. Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes. Diabet Med. 2017;34(5):667–75.

    Article  PubMed  Google Scholar 

  29. Grigorian EG, et al. Financial barriers in emerging adults with type 1 diabetes: a qualitative analysis. Diabetes Spectr. 2022;35(2):190–7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gutierrez-Colina AM, et al. Young adults with type 1 diabetes preparing to transition to adult care: psychosocial functioning and associations with self-management and health outcomes. Diabetes Spectr. 2020;33(3):255–63.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hu TY, et al. The association between pediatric mental health disorders and type 1 diabetes-related outcomes. Pediatr Diabetes. 2022;23(4):507–15.

    Article  PubMed  Google Scholar 

  32. Johnson B, et al. Medical and psychological outcomes for young adults with type 1 diabetes: no improvement despite recent advances in diabetes care. Diabet Med. 2014;31(2):227–31.

    Article  CAS  PubMed  Google Scholar 

  33. Kellett J, et al. Young people’s experiences of managing type 1 diabetes at University: a National study of UK university students. Diabet Med. 2018;35(8):1063–71.

    Article  CAS  PubMed  Google Scholar 

  34. LaBarbera B, et al. Diabetes-related events in adolescents and young adults: opportunities for psychosocial interventions. Psychol Health Med. 2019;24(9):1148–57.

    Article  PubMed  Google Scholar 

  35. Leung J, et al. The four i’s of adolescent transition in type 1 diabetes care: a qualitative study. Diabet Med. 2021;38(7):e14443.

    Article  PubMed  Google Scholar 

  36. Little JM, Odiaga JA, Minutti CZ. Implementation of a diabetes transition of care program. J Pediatr Health Care. 2017;31(2):215–21.

    Article  PubMed  Google Scholar 

  37. Lotstein DS, et al. Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence. Pediatrics. 2013;131(4):e1062–70.

    Article  PubMed  PubMed Central  Google Scholar 

  38. McDowell ME, Litchman ML, Guo JW. The transition experiences of adolescents with type 1 diabetes from paediatric to adult care providers. Child Care Health Dev. 2020;46(6):692–702.

    Article  PubMed  Google Scholar 

  39. Nakhla M, et al. Transition to adult care for youths with diabetes mellitus: findings from a universal health care system. Pediatrics. 2009;124(6):e1134–41.

    Article  PubMed  Google Scholar 

  40. Quinn SM, et al. Utility of psychological screening of young adults with type 1 diabetes transitioning to adult providers. Endocr Pract. 2016;22(9):1104–10.

    Article  PubMed  Google Scholar 

  41. Sawyer B, et al. Barriers and strategies for type 1 diabetes management among emerging adults: a qualitative study. Clin Med Insights Endocrinol Diabetes. 2022;15:11795514221098389.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Skedgell KK, et al. Defining features of diabetes resilience in emerging adults with type 1 diabetes. Pediatr Diabetes. 2021;22(2):345–53.

    Article  PubMed  Google Scholar 

  43. Sullivan-Bolyai S, et al. Engaging teens and parents in collaborative practice: perspectives on diabetes self-management. Diabetes Educ. 2014;40(2):178–90.

    Article  PubMed  Google Scholar 

  44. Weigensberg MJ, et al. Diabetes empowerment council: integrative pilot intervention for transitioning young adults with type 1 diabetes. Glob Adv Health Med. 2018;7:2164956118761808.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wiley J, et al. Multidisciplinary diabetes team care: the experiences of young adults with type 1 diabetes. Health Expect. 2015;18(5):1783–96.

    Article  PubMed  Google Scholar 

  46. Egan EA, Corrigan J, Shurpin K. Building the bridge from pediatric to adult diabetes care: making the connection. Diabetes Educ. 2015;41(4):432–43.

    Article  PubMed  Google Scholar 

  47. Gee L, et al. The clinical, psychosocial, and socioeconomic concerns of urban youth living with diabetes. Public Health Nurs. 2007;24(4):318–28.

    Article  PubMed  Google Scholar 

  48. Perry L, et al. Services doing the best they can: service experiences of young adults with type 1 diabetes mellitus in rural Australia. J Clin Nurs. 2012;21(13–14):1955–63.

    Article  PubMed  Google Scholar 

  49. Perry L, et al. Lost in transition? Access to and uptake of adult health services and outcomes for young people with type 1 diabetes in regional new South Wales. Med J Aust. 2010;193(8):444–9.

    Article  PubMed  Google Scholar 

  50. Price CS, et al. Implementing a transition pathway in diabetes: a qualitative study of the experiences and suggestions of young people with diabetes. Child Care Health Dev. 2011;37(6):852–60.

    Article  CAS  PubMed  Google Scholar 

  51. Tsevat RK, Weitzman ER, Wisk LE. Indicators of healthcare transition progress among college youth with type 1 diabetes. Acad Pediatr. 2023;23(4):737–46.

    Article  PubMed  Google Scholar 

  52. Alwadiy F, et al. Association of self-efficacy, transition readiness and diabetes distress with glycemic control in adolescents with type 1 diabetes preparing to transition to adult care. Can J Diabetes. 2021;45(5):490–5.

    Article  PubMed  Google Scholar 

  53. Lašaitė L, et al. Diabetes distress in males and females with type 1 diabetes in adolescence and emerging adulthood. J Diabetes Complications. 2016;30(8):1500–5.

    Article  PubMed  Google Scholar 

  54. Michaud S, et al. Adult care providers’ perspectives on the transition to adult care for emerging adults with type 1 diabetes: a cross-sectional survey. Diabet Med. 2018;35(7):846–54.

    Article  CAS  PubMed  Google Scholar 

  55. Ng AH, et al. Needs of young adults with type 1 diabetes during life transitions - an Australian-Danish experience. Patient Educ Couns. 2022;105(5):1338–41.

    Article  PubMed  Google Scholar 

  56. Sattoe J et al. Transfer in care and diabetes distress in young adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care. 2021;9(2).

  57. Alassaf A, et al. Predictors of type 1 diabetes mellitus outcomes in young adults after transition from pediatric care. J Diabetes. 2017;9(12):1058–64.

    Article  CAS  PubMed  Google Scholar 

  58. Baechle C, et al. Course of screening-based depression in young adults with a long type 1 diabetes duration: prevalence and transition probabilities - a cohort study. Diabetes Res Clin Pract. 2022;185:109220.

    Article  PubMed  Google Scholar 

  59. Bronner MB, et al. The impact of type 1 diabetes on young adults’ health-related quality of life. Health Qual Life Outcomes. 2020;18(1):137.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Fisher E, et al. Association between glycemic control and clinic attendance in emerging adults with type 1 diabetes: a tertiary center experience. J Diabetes Res. 2018;2018:p9572817.

    Article  Google Scholar 

  61. Gray S, et al. A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well-being to their clinical course in young people with type 1 diabetes mellitus during transition from child to adult health services. Diabet Med. 2018;35(9):1216–22.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Insabella G, et al. The transition to young adulthood in youth with type 1 diabetes on intensive treatment. Pediatr Diabetes. 2007;8(4):228–34.

    Article  PubMed  Google Scholar 

  63. Mello D, et al. Neighborhood disadvantage, parent-adolescent relationship quality, and type 1 diabetes in late adolescents transitioning to early emerging adulthood. Soc Sci Med. 2020;255:113010.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Spaic T, et al. Closing the gap: results of the multicenter Canadian randomized controlled trial of structured transition in young adults with type 1 diabetes. Diabetes Care. 2019;42(6):1018–26.

    Article  PubMed  Google Scholar 

  65. Vallis M, Willaing I, Holt RIG. Emerging adulthood and type 1 diabetes: insights from the DAWN2 study. Diabet Med. 2018;35(2):203–13.

    Article  CAS  PubMed  Google Scholar 

  66. Wdowik MJ, Kendall PA, Harris MA. College students with diabetes: using focus groups and interviews to determine psychosocial issues and barriers to control. Diabetes Educ. 1997;23(5):558–62.

    Article  CAS  PubMed  Google Scholar 

  67. Pyatak E. Participation in occupation and diabetes self-management in emerging adulthood. Am J Occup Ther. 2011;65(4):462–9.

    Article  PubMed  Google Scholar 

  68. Pyatak EA, Florindez D, Weigensberg MJ. Adherence decision making in the everyday lives of emerging adults with type 1 diabetes. Patient Prefer Adherence. 2013;7:709–18.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Baucom KJW, et al. Depressive symptoms and diabetes management from late adolescence to emerging adulthood. Health Psychol. 2018;37(8):716–24.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Berg CA, et al. Executive function predicting longitudinal change in type 1 diabetes management during the transition to emerging adulthood. Diabetes Care. 2018;41(11):2281–8.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Butalia S, et al. Youth with diabetes and their parents’ perspectives on transition care from pediatric to adult diabetes care services: a qualitative study. Health Sci Rep. 2020;3(3):e181.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Ersig AL, et al. Stressors in teens with type 1 diabetes and their parents: immediate and long-term implications for transition to self-management. J Pediatr Nurs. 2016;31(4):390–6.

    Article  PubMed  Google Scholar 

  73. Hilliard ME, et al. Perspectives from before and after the pediatric to adult care transition: a mixed-methods study in type 1 diabetes. Diabetes Care. 2014;37(2):346–54.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Markowitz B, et al. The 3i conceptual framework for recognizing patient perspectives of type 1 diabetes during emerging adulthood. JAMA Netw Open. 2019;2(7):e196944.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Schmidt S, et al. Differential effect of a patient-education transition intervention in adolescents with IBD vs. diabetes. Eur J Pediatr. 2018;177(4):497–505.

    Article  PubMed  Google Scholar 

  76. Suchy Y, et al. Executive cognitive functions and behavioral control differentially predict HbA1c in type 1 diabetes across emerging adulthood. J Int Neuropsychol Soc. 2020;26(4):353–63.

    Article  PubMed  Google Scholar 

  77. Wilson V. Students’ experiences of managing type 1 diabetes. Paediatr Nurs. 2010;22(10):25–8.

    Article  PubMed  Google Scholar 

  78. Kime N. Join us on our journey: exploring the experiences of children and young people with type 1 diabetes and their parents. Practical Diabetes. 2014;31(1):24–8.

    Article  Google Scholar 

  79. Montali L, et al. Barriers and facilitators of type 1 diabetes self-care in adolescents and young adults. J Pediatr Nurs. 2022;62:136–43.

    Article  PubMed  Google Scholar 

  80. Abdoli S, Hardy LR, Hall J. The complexities of struggling to live life. Diabetes Educ. 2017;43(2):206–15.

    Article  PubMed  Google Scholar 

  81. Helgeson VS, et al. Cognitive adaptation theory as a predictor of adjustment to emerging adulthood for youth with and without type 1 diabetes. J Psychosom Res. 2014;77(6):484–91.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Williams S, et al. A province wide review of transition practices for young adult patients with type 1 diabetes. J Eval Clin Pract. 2021;27(1):111–8.

    Article  PubMed  Google Scholar 

  83. Colver A, et al. A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions. BMC Med. 2018;16(1):111.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Holtz BE, MK, Holmstrom AJ, Cotten SR, Hershey DD, Dunneback JK, Vega JJ, Wood MA. Teen and parental perspectives regarding transition of care in type 1 diabetes. Child Youth Serv Rev. 2020;110(104800).

  85. Karlsson A, Arman M, Wikblad K. Teenagers with type 1 diabetes–a phenomenological study of the transition towards autonomy in self-management. Int J Nurs Stud. 2008;45(4):562–70.

    Article  PubMed  Google Scholar 

  86. Pacaud D, Yale JF, et al. Problems in transition from pediatric care to adult care for individuals with diabetes. Can J Diabetes. 2005;29(1):13–8.

    Google Scholar 

  87. Simms M, Baumann K, Monaghan M. Health communication experiences of emerging adults with type 1 diabetes. Clin Pract Pediatr Psychol. 2017;5(4):415–25.

    PubMed  PubMed Central  Google Scholar 

  88. Sparud-Lundin C, Ohrn I, Danielson E. Redefining relationships and identity in young adults with type 1 diabetes. J Adv Nurs. 2010;66(1):128–38.

    Article  PubMed  Google Scholar 

  89. Visagie E, van Rensburg E, Deacon E. Social support effects on diabetes management by South African emerging adults: a replication and extension study. Taylor & Francis. 2018: pp. 504–509.

  90. While AE, et al. Health-related quality of life of young people with long-term illnesses before and after transfer from child to adult healthcare. Child Care Health Dev. 2017;43(1):144–51.

    Article  CAS  PubMed  Google Scholar 

  91. Rasmussen B, et al. Psychosocial factors impacting on life transitions among young adults with type 2 diabetes: an Australian - Danish qualitative study. Scand J Caring Sci. 2016;30(2):320–9.

    Article  CAS  PubMed  Google Scholar 

  92. Agarwal S, et al. Transfer from paediatric to adult care for young adults with type 2 diabetes: the SEARCH for diabetes in youth study. Diabet Med. 2018;35(4):504–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Raymond JK et al. Looking forward to transition: perspectives on transition from pediatric to adult diabetes care. Diabetes Manag (Lond). 2013;3(4).

  94. Pundyk KJ, et al. Transition of youth with type 2 diabetes: predictors of health-care utilization after transition to adult care from population-based administrative data. Can J Diabetes. 2021;45(5):451–7.

    Article  PubMed  Google Scholar 

  95. Duke DC, Shimomaeda RJ, Marris L. Recommendations for transition from pediatric to adult diabetes care: patient’s perspectives. Diabetes Manage (London). 2013;3(4):297–304.

    Article  CAS  Google Scholar 

  96. Gerber BS, et al. Evaluation of an internet diabetes self-management training program for adolescents and young adults. Diabetes Technol Ther. 2007;9(1):60–7.

    Article  PubMed  Google Scholar 

  97. Wysocki T, et al. Diabetes mellitus in the transition to adulthood: adjustment, self-care, and health status. J Dev Behav Pediatr. 1992;13(3):194–201.

    Article  CAS  PubMed  Google Scholar 

  98. Nip ASY, Lodish M. Trend of diabetes-related hospital admissions during the transition period from adolescence to adulthood in the state of California. Diabetes Care. 2021;44(12):2723–8.

    Article  PubMed  Google Scholar 

  99. Ames JL, et al. Healthcare service utilization and cost among transition-age youth with autism spectrum disorder and other special healthcare needs. Autism. 2021;25(3):705–18.

    Article  PubMed  Google Scholar 

  100. Zhu L, et al. Persistent anxiety is associated with higher glycemia post-transition to adult services in Asian young adults with diabetes. Diabetes Metab J. 2021;45(1):67–76.

    Article  PubMed  Google Scholar 

  101. Richards J, et al. Engagement in household chores in youth with chronic conditions: health care transition implications. OTJR (Thorofare N J). 2021;41(1):6–14.

    PubMed  Google Scholar 

  102. Pyatak EA, et al. Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with type 1 diabetes. Diabet Med. 2014;31(12):1615–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Tremblay ES, et al. Health care transition in youth with type 1 diabetes and an A1C > 9%: qualitative analysis of pre-transition perspectives. Diabetes Spectr. 2020;33(4):331–8.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Van Walleghem N, MacDonald CA, Dean HJ. Building connections for young adults with type 1 diabetes mellitus in Manitoba: feasibility and acceptability of a transition initiative. Chronic Dis Can. 2006;27(3):130–4.

    PubMed  Google Scholar 

  105. Vidal Flor M, et al. Type 1 diabetes patient experiences before and after transfer from a paediatric to an adult hospital. Patient Prefer Adherence. 2022;16:2229–46.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Walsh Ó, et al. The perceptions of patients, their parents and healthcare providers on the transition of young adults with type 1 diabetes to adult services in the West of Ireland. Ir Med J. 2018;111(7):787.

    CAS  PubMed  Google Scholar 

  107. Ali N, Longson J et al. Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service. J Transition Med. 2021;3(1).

  108. Garvey KC, et al. Health care transition in young adults with type 1 diabetes: barriers to timely establishment of adult diabetes care. Endocr Pract. 2013;19(6):946–52.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Giménez M, et al. Disturbed eating behaviours and glycaemic control in young subjects with type 1 diabetes transferred from a paediatric to an adult diabetes unit. Diabet Med. 2008;25(7):884–5.

    Article  PubMed  Google Scholar 

  110. Goethals ER, et al. Health care transition in type 1 diabetes: perspectives of diabetes care and education specialists caring for young adults. Diabetes Educ. 2020;46(3):252–60.

    Article  PubMed  Google Scholar 

  111. Helgeson VS. Diabetes burnout among emerging adults with type 1 diabetes: a mixed methods investigation. J Behav Med. 2021;44(3):368–78.

    Article  PubMed  Google Scholar 

  112. Pasquini S, et al. Growing up with type 1 diabetes mellitus: data from the Verona diabetes transition project. Diabet Med. 2022;39(4):e14719.

    Article  PubMed  Google Scholar 

  113. Sritharan A et al. Eight-year retrospective study of young adults in a diabetes transition clinic. Int J Environ Res Public Health. 2021;18(23).

  114. Pyatak EA, et al. Clinical and psychosocial outcomes of a structured transition program among young adults with type 1 diabetes. J Adolesc Health. 2017;60(2):212–8.

    Article  PubMed  Google Scholar 

  115. Sequeira PA, et al. Let’s empower and prepare (LEAP): evaluation of a structured transition program for young adults with type 1 diabetes. Diabetes Care. 2015;38(8):1412–9.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Chiang YT, et al. Emergence of a butterfly: the life experiences of type 1 diabetes Taiwanese patients during the 16–25 years old transition period. Int J Qual Stud Health Well-being. 2020;15(1):1748362.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Hanna KM, et al. Initial findings: primary diabetes care responsibility among emerging adults with type 1 diabetes post high school and move out of parental home. Child Care Health Dev. 2013;39(1):61–8.

    Article  CAS  PubMed  Google Scholar 

  118. Markowitz JT, Laffel LM. Transitions in care: support group for young adults with type 1 diabetes. Diabet Med. 2012;29(4):522–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  119. Tracy EL, et al. Health-risk behaviors and type 1 diabetes outcomes in the transition from late adolescence to early emerging adulthood. Child Health Care. 2019;48(3):285–300.

    Article  PubMed  Google Scholar 

  120. Gupta A, et al. Characteristics of young adults with multiple episodes of diabetic ketoacidosis. Intern Med J. 2019;49(7):911–4.

    Article  CAS  PubMed  Google Scholar 

  121. Sauder KA, et al. Disparities in hemoglobin A(1c) testing during the transition to adulthood and association with diabetes outcomes in youth-onset type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2021;44(10):2320–8.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Pediatric Dyslipidemia A, Ashraf E. Switzerland. Springer Nature; 2023. p. 132.

  123. Sauder KA, et al. Disparities in hemoglobin A(1c) testing during the transition to adulthood and association with diabetes outcomes in youth-onset type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2021.

  124. Peters A, Laffel L, t.A.D.A.T W, Group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care. 2011;34(11):2477–2485.

  125. Dabelea D, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA. 2017;317(8):825–35.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Group TS, et al. Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021;385(5):416–26.

    Article  Google Scholar 

  127. Peña AS, et al. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian paediatric endocrine group guidelines. Med J Aust. 2020;213(1):30–43.

    Article  PubMed  Google Scholar 

  128. Hill-Briggs F, et al. Social determinants of health and diabetes: a scientific review. Diabetes Care. 2021;44(1):258–79.

    Article  Google Scholar 

  129. Walker RJ, Williams JS, Egede LE. Influence of race, ethnicity and social determinants of health on diabetes outcomes. Am J Med Sci. 2016;351(4):366–73.

    Article  PubMed  PubMed Central  Google Scholar 

  130. Ellis BJ, et al. The evolutionary basis of risky adolescent behavior: implications for science, policy, and practice. Dev Psychol. 2012;48(3):598–623.

    Article  PubMed  Google Scholar 

  131. American Diabetes Association Professional Practice Committee.14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S258-S281.

  132. Trief PM, et al. Psychosocial factors and glycemic control in young adults with youth-onset type 2 diabetes. JAMA Netw Open. 2024;7(4):e245620.

    Article  PubMed  PubMed Central  Google Scholar 

  133. Trief PM, et al. Medication adherence in young adults with youth-onset type 2 diabetes: iCount, an observational study. Diabetes Res Clin Pract. 2022;184:109216.

    Article  PubMed  Google Scholar 

  134. Trief PM, et al. Diabetes distress in young adults with Youth-onset type 2 diabetes: tODAY2 study results. Diabetes Care. 2022;45(3):529–37.

    Article  PubMed  PubMed Central  Google Scholar 

  135. Garvey KC, et al. Health care utilization trends across the transition period in a national cohort of adolescents and young adults with type 1 diabetes. Diabetes Care. 2022;45(11):2509–17.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Edmondson EK, et al. Emerging adults with type 2 diabetes: understanding illness experience and transition to adult care. J Adolesc Health. 2024;75(1):107–14.

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

Open access funding provided by the National Institutes of Health

STC and TC are supported by the Intramural Program of the National Institute of Diabetes and Kidney and Digestive Disease, National Institutes of Health, Bethesda, Maryland. AU and SA are supported by the National Institutes of Health Clinical Center.

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  1. Assumpta O. Ude and Sydney A. Dixon are co-first authors.

Authors and Affiliations

  1. Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA

    Assumpta O. Ude & Sue-Ann Arboine

  2. Section on Pediatric Diabetes, Obesity, and Metabolism, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 10 Center Drive, BLD-10 CRC, RM 5-5942, Bethesda, MD, 20814, USA

    Sydney A. Dixon, Sophia B. Glaros & Stephanie T. Chung

  3. National Institutes of Health Library, National Institutes of Health, Bethesda, MD, USA

    Nancy L. Terry

  4. Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA

    Tomás Cabeza De Baca

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Contributions

STC and AU conceptualized and designed the study. STC, AU, SD, and TC designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript, and revised the manuscript. SBG and SA analyzed the data and revised the manuscript. NT designed the study, conducted literature search, and revised the manuscript. All authors approved final version of manuscript.

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Ude, A.O., Dixon, S.A., Glaros, S. et al. Transitioning to adult care in youth-onset diabetes: a scoping review of socio-ecological factors in youth-onset type 2 diabetes compared to type 1 diabetes. BMC Public Health 25, 1784 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12889-025-22956-1

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