https://link.springer.com/article/10.1007/s00125-026-06803-5

The transition of youth with diabetes from paediatric to adult diabetes care services:

a consensus report of the joint working group of

the International Society for Pediatric and Adolescent Diabetes (ISPAD),

the European Association for the Study of Diabetes (EASD)

and the American Diabetes Association (ADA)

 

Consensus Report
Published: 14 September 2026

Vol.:(0123456789)

Diabetologia

https://doi.org/10.1007/s00125-026-06803-5

CONSENSUS REPORT

 

Carine de Beaufort 1,2,3 · Steven James4,5,6 · Jill Weissberg‑Benchell7 · Apoorva Gomber8 · Laura Cudizio9 ·

Nisa M. Maruthur10 · Sarah K. Lyons11 · Frank Snoek12 · Sze May Ng 13,14 · Aleksandra Araszkiewicz 15 ·

Eva Hagström Toft

 

 

 

Abstract

Young adulthood is a period of significant and unique physiological, psychological, sexual and social upheaval. Related challenges can have an impact on effective diabetes self-management, with high rates of unplanned healthcare use recorded for many, and consequent increases in the risks of premature morbidity and mortality. Healthcare professionals need guidance in delivering transition support for adolescents and young adults with diabetes.

This would help to facilitate the formulation and implementation of local policies and procedures, enabling guidelines to be translated into practice and improving transition of care readiness. This led ISPAD, EASD and ADA to convene a working group to produce a consensus report on the transition from paediatric to adult diabetes healthcare services.

The ACCORD and AGREE II recommendations for the development of consensus reports and clinical guidelines, respectively, were followed. Existing diabetes-specific recommendations on the transition of care, published statements, a prior position paper, general recommendations and online toolkits were initially identified and reviewed. Current evidence was then systematically reviewed, supplemented with primary data on the perceptions and experiences of healthcare professionals and of people with diabetes and their caregivers from global surveys. Evidence with a grading of A or B was automatically included in the consensus statements; evidence with a C or E grading was subjected to a Delphi survey for validation. Consensus was obtained for 31 statements on the full transition of care continuum and the three unique stages of pre-transfer, transfer and post-transfer.

This consensus report should be viewed as a guide and adjusted to local settings.

 

 

Läs hela artrikeln open source pdf free

https://link.springer.com/article/10.1007/s00125-026-06803-5

 

From the article

Background and rationale

Young adulthood can be a period of significant and unique

physiological, psychological, sexual and social upheaval

[1–3].

 

The challenges of becoming an adult, coupled with

an actively developing prefrontal cortex, which is crucial

for complex functions such as decision-making, planning

and impulse control, can impact on effective diabetes self-

management and consequently diabetes-related outcomes.

Healthcare services for young adults with diabetes, which

are key to support diabetes self-management and early

complication detection and treatment, are inconsistent

[4–6]. This is observed worldwide. High rates of missed

healthcare contacts, emergency service use and inpatient

admissions have been observed in the period of transition

from paediatric to adult care [4, 5, 7], with consequent

increases in risks of premature morbidity and mortality

[4, 5, 8–14].

 

 

Adolescents and young adults with diabetes need uninter-

rupted access to specialised medical care, peer support, and

safe school and work environments to enable them to gain

the confidence and skills needed to independently manage

their disease. Negative health outcomes in young adulthood

may, in part, occur due to unsuccessful transition from pae-

diatric to adult-based diabetes healthcare services [15, 16].

Transition of care is defined as the purposeful, planned pro-

cess of adolescents and young adults with chronic physical

and medical conditions from child-centred to adult-oriented

healthcare systems [17]. This transition typically starts in

early adolescence and ends during the stage of emerging

adulthood. It is more than the simple transfer of a medical

file or a transfer letter; instead, transition of care should be

planned, prepared and individualised, based on constant and

constructive collaboration between the person with diabetes,

their caregivers, and the paediatric and adult diabetes health-

care teams [3, 17]. Before the actual transfer of a person with

diabetes (pre-transfer) from (specialised) paediatric care to

adult care, attainment of the knowledge and skills impor-

tant for this transfer and integration into the adult healthcare

system is vital. This transition readiness helps determine

whether transition completion (post-transfer) will be suc-

cessful, with positive integration into adult care, both spe-

cialised and general medical practice.

 

 

Healthcare professionals and services need guidance in

delivering support around the transition of care. This would

help to facilitate the formulation and implementation of local

policies and procedures, enabling guidelines to be translated

into practice and promoting transition readiness. Given the

heterogeneity of diabetes care models worldwide and the

multitude of factors that may influence the transition process,

including age, financial resources, preferences of people with

diabetes and their caregivers, healthcare delivery and access,

and national policies, differences in transition models are to

be expected [18–22]. Online educational resources for transi-

tion of care may exist in some countries and regions but are

absent in others [23].

 

 

Collectively, this led ISPAD, EASD

and ADA to convene a working group of specialists in this

field to develop a consensus report on transition from paedi-

atric to adult diabetes healthcare services, ensuring that the

perceptions of paediatric- and adult-based healthcare profes-

sionals and people with diabetes and their caregivers world-

wide were incorporated. The main objective of this consensus

report was to inform healthcare professionals on the best pos-

sible and most acceptable way to diagnose and treat certain

diseases, and address a decision-making area [23].

 

 

Discussion

To develop this consensus report, a group of experts with

different professional backgrounds and including people

with lived experience critically reviewed existing profes-

sional recommendations, based on evidence and expert opin-

ion. In addition, they performed a systematic review (quan-

titative, qualitative), supplemented by international surveys

capturing the views of people with diabetes, their caregivers

and healthcare professionals, making this the most complete

and up-to-date consensus report on the transition of youth

with diabetes from paediatric to adult diabetes care services.

 

 

Consensus within the working group was obtained for 31

statements on the transition of care continuum and the three

unique stages of pre-transfer, transfer and post-transfer for

the transition from paediatric to adult diabetes care. After

achievement of over 90% endorsement by the Delphi panel

for the 26 statements with limited evidence (grade E), all

statements were transformed into transition guidance with

links to existing readiness and assessment tools [31, 33,

65–67].

 

As differences in healthcare systems and clinical

and ambulatory care, as well as inter-individual differences,

will influence the transition of care trajectory, this consensus

report should be adjusted to local settings. Paediatric diabe-

tes teams will have different compositions in different set-

tings. In some centres the healthcare professional team will

include specialised paediatricians, nurses, nurse educators,

psychologists, social workers, dietitians and pharmacists,

whereas in other centres it may include one general paedia-

trician and/or a nurse. It is important to define responsibili-

ties with respect to transition. The template for the devel-

opment and implementation of a diabetes-related transition

policy/guide is universal, but the content should be specific

to and feasible for the location where care will be provided.

 

 

For example, recognising the vulnerability of people with

diabetes and the provision of ongoing medical, mental and

psychosocial support to empower them are vital. If a direc-

tory of adult healthcare professionals is not available at the

time of transfer, alternative solutions could be identified,

such as the use of peer support. This will not replace follow-

up by adult healthcare professionals, but it may prevent peo-

ple with diabetes dropping out of care. In collaboration with

the scientific societies and their members, the development

of a global directory, accessible online, could be envisaged.

 

 

Over time, a structured approach towards the transition pro-

cess will, together with long-term surveillance, provide bet-

ter insights into best practice and cost-effectiveness.

Regardless of local setting, the diabetes-related transition

policy/guide should provide clear information for people liv-

ing with diabetes and their caregivers on the approach to

transition preparation, readiness assessment, and the actual

transfer to adult diabetes healthcare. This document should

be developed in collaboration between the paediatric and

adult diabetes healthcare teams involved in the transition

process, people living with diabetes and their caregiv-

ers and, where possible, other key stakeholders, including

general practitioners. Such a policy/guide should be shared

with people living with diabetes who are receiving care and

their caregivers 12–24 months before the anticipated time

of transfer.

 

 

A clear policy/guide will include many of the consensus

statements. For example, paediatric (and where applicable

adult) diabetes healthcare professionals should be knowl-

edgeable about their roles and responsibilities around tran-

sition planning and preparation for people with diabetes

and their caregivers. They should help provide knowledge

and skills so that people with diabetes and their caregiv-

ers can recognise and understand their own unique needs,

facilitating transition to a different diabetes healthcare

setting. Transition-related topics should be integrated

into ongoing diabetes education in an age-appropriate

and developmentally appropriate way, again commencing

early on at least 12–24 months before transfer. Introducing

transition-related topics early allows ample time to assess

the diabetes-related knowledge and skills of the person

with diabetes and identify gaps, with additional education

provided where warranted. The education provided should

not be limited to diabetes-specific topics but should also

include general topics such as birth control and pregnancy

planning (where applicable), use of alcohol and illicit

drugs, and smoking.

 

 

Based on the setting, information on and preparation

around potential changes in access to diabetes-related tech-

nology and medicines, financial costs and insurance cover-

age should be covered. Clear communication about these

practical aspects may enable informed planning and help

to reduce anxiety. Screening for metabolic outcomes and

both micro- and macrovascular complications should also

be conducted, as recommended in international consensus

guidelines [38, 43]. This should include assessment of men-

tal health and psychosocial issues, with appropriate action

undertaken should problems be identified.

 

 

Finally, independent of the location, paediatric and adult

diabetes healthcare professionals working with people with

diabetes and their caregivers should be aware of the vulner-

abilities of and different challenges experienced by those

under their care, both diabetes- and non-diabetes-related.

The support provided should be individualised, and treat-

ment adherence and diabetes self-management should be

encouraged. At all times it is important that people with

diabetes and their caregivers feel comfortable voicing their

transition-related questions and concerns. Timely and com-

prehensive communication between paediatric and adult dia-

betes healthcare teams is essential throughout. Key informa-

tion, including the diabetes management and complication

history of the people with diabetes, should be promptly dis-

seminated. This communication helps to ensure clarity and

alignment across diabetes healthcare teams, while empha-

sising patient-centred care. The use of a transition readiness

checklist can help to ensure that comprehensive education

and assessment is completed prior to transfer; multiple tools

have been validated and are freely accessible [67]. Individual

centres should decide which transition readiness tool they

will use.

 

 

Tracking and monitoring the transition process and related

outcomes will be essential to evaluate the transition process

and quality of care provided and received. When adult and

paediatric centres use electronic health records, ongoing eval-

uation and improvement will be more feasible. For example,

the Plan Do Study Act (PDSA) cycle is a helpful tool for

demonstrating value-based healthcare [68, 69]. Increased

access to outcome data would allow implementation of this

tool, generating the crucial robust and long-term data (at least

3–5 years) that are needed for better understanding of the

transition process and ongoing quality improvement.

Although we fully acknowledge the potential risk of

bias in the reported systematic reviews, the key outcome of

these literature reviews is the pressing need for additional

evidence, including longer term follow-up, consistent use

of outcome indicators, studies not limited to analyses of

metabolic control or access to emergency services, and

better descriptions of determinants of successful transition

(including ethnicity and gender) and critical characteristics

of healthcare systems. They also highlight, in particular, the

need for RCTs and longitudinal research. A particular gap

is the lack of research on the transition of care in youth with

type 2 diabetes, including the impact of healthcare system-

related factors.

 

 

The development of a centre-based transition policy, taking

into account the consensus statements and tracking/monitor-

ing, is an essential step to improve the outcomes of transition.

As more evidence becomes available, there will be a need

to update these consensus strategies.

In time, they may evolve into regular chapters in key pub-

lications, including the ISPAD clinical practice guidelines

and ADA standards of care.

 

 

 

Nyhetsibfo

www red DiabetologNytt