ESPE Yearbook of Paediatric Endocrinology

J Clin Endocrinol Metab. 2025 Apr 15:dgaf239. doi: 10.1210/clinem/dgaf239

Brief Summary: This cross-sectional single center cohort study assessed 65 youth with T2D as they transitioned from pediatric to adult carein the diabetes clinic at the National Institutes of Health (NIH) Clinical Center between January 2021 and December 2024. The multidisciplinary transition team included a pediatric endocrinologist, an internal medicine/pediatric endocrinologist, an adult endocrinologist, a psychologist, dieticians, a pharmacist, a certified diabetes care and education specialist, and a clinical research coordinators/patient navigator. The clinic integrates participants into an adult-care model without changing clinicians. Despite this comprehensive setup, 95% of participants reported significant psychosocial challenges, including stress, socioeconomic hardship, and mood symptoms, which were linked to reduced transition readiness.

Comment: There has been growing interest in the role of pediatric-to-adult transitional care in improving health outcomes among children and young adults with pediatric-onset chronic conditions.¹ While factors that promote or impede the transition of diabetes care in youth with type 1 diabetes are well described, much less is known about the transition of care in youth with T2D. Considering the rising incidence of early-onset T2D and the importance of a successful transition from pediatric to adult care for ensuring positive long-term outcomes, this article is both timely and important.

Based on the Six Core Elements of Health Care Transition²—which identify age 14 as the starting point for assessing transition readiness, given that adolescents at this age exhibit decision-making patterns similar to those of young adults, although emotional regulation, motivation, and behavioral control may continue to develop until age 24—the eligible population included adolescents and young adults aged 14 to 24 years.

These findings indicate a widespread lack of readiness for transition. Major perceived obstacles included difficulty scheduling specialist appointments, transportation barriers, challenges navigating insurance coverage, managing diabetes self-care when ill, and handling prescriptions. Notably, 68% of participants reported social, emotional, and cognitive challenges; more than 50% were worried about their future, approximately 40% reported frequent sadness and attention difficulties, 46% reported feeling burdened by diabetes, 25% experienced diabetes “burnout,” and 15% felt unable to keep their blood sugars in range and reported that diabetes care interfered with daily activities. Mood symptoms were associated with a nearly tenfold increase in the likelihood of experiencing mild cognitive challenges, such as forgetfulness and poor attention. These findings align with previous report from the SEARCH study, which indicated that 29% of youth with T2D did not transition to adult care and 15% reported receiving no care at all.³

Key message: This timely study sheds light on the understudied experiences of youth with T2D during healthcare transition. It underscores the urgent need for personalized, multidisciplinary interventions to optimize care continuity in this vulnerable population.

References: 1. Marani H, Fujioka J, Tabatabavakili S, Bollegala N. Systematic narrative review of pediatric-to-adult care transition models for youth with pediatric-onset chronic conditions. Children and Youth Services Review. 2020 Nov 1;118:105415.2. Ishizaki Y, Ochiai R, Maru M. Editorial: Advances of health care transition for patients with childhood-onset chronic diseases: International perspectives, volume II. Front Pediatr. 2023 Feb 13;11:1147397. doi: 10.3389/fped.2023.1147397.3. Agarwal S, Raymond JK, Isom S, Lawrence JM, Klingensmith G, Pihoker C, Corathers S, Saydah S, D’Agostino RB Jr, Dabelea D. Transfer from paediatric to adult care for young adults with Type 2 diabetes: the SEARCH for Diabetes in Youth Study. Diabet Med. 2018 Apr;35(4):504-512. doi: 10.1111/dme.13589.