Diabetes mellitus management - psychosocial factors impacting the care of young adult patients with diabetes transitioning from paediatric care

Overview

Psychosocial factors - including the transition from paediatric to adult diabetes care, socioeconomic circumstances, mental health comorbidity, and social support - substantially influence diabetes self-management capacity and glycaemic outcomes, requiring active assessment and support alongside medical management
The paediatric-to-adult care transition specifically is a recognised high-risk period, associated with a well-documented decline in engagement and glycaemic control if not actively managed with a structured transition process

Adolescence/young adulthood combines developmental factors (increasing autonomy, identity formation, risk-taking behaviour) with the practical shift from parent-supported paediatric care to independent self-management in adult services - this combination explains why the transition period carries disproportionate risk of disengagement and deteriorating control compared with other life stages

Structured transition programmes (gradual handover, transition clinics/coordinators, clear communication between paediatric and adult teams) reduce the risk of disengagement compared with an abrupt service transfer
Broader psychosocial assessment (mental health screening, socioeconomic circumstances, social support network) should be integrated into routine diabetes review, not treated as a separate, optional consideration

Structured, gradual transition processes (rather than an abrupt single handover appointment) improve continuity of engagement and glycaemic outcomes through the paediatric-to-adult transition
Mental health comorbidity (depression, anxiety, eating disorders - particularly relevant given the specific intersection with insulin omission for weight control in some patients) requires active screening and coordinated management alongside diabetes care

Paediatric-to-adult transition risk period, insulin omission for weight control ("diabulimia" - a specific, serious eating disorder variant in insulin-treated diabetes), socioeconomic barriers to self-management, mental health comorbidity screening

The paediatric-to-adult diabetes care transition is a well-recognised high-risk period for disengagement and deteriorating glycaemic control - a structured, gradual transition process (rather than an abrupt handover) is itself an evidence-based intervention, not simply an administrative formality

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