Building Better Transitions for Young Adults With Type 1 Diabetes
Moving from paediatric to adult diabetes services is a major clinical and life transition. For a young person with type 1 diabetes, it can coincide with leaving school, starting university or work, moving away from home, managing money, and taking greater responsibility for insulin, appointments, food, exercise, and sick-day care. A well-designed transitional care model should recognise this wider context rather than treat the transfer as a single referral.
In Queensland, the distance between a paediatric hospital in Brisbane and an adult service in regional or remote communities can shape whether care is practical and consistent. Evaluating a Transitional Care Model for Young Adults with Type 1 Diabetes Leaving Paediatric Services therefore requires more than measuring HbA1c. It should examine safety, confidence, access, cultural responsiveness, service coordination, and the experience of young people and their families.
Why The Transfer Point Matters
Paediatric diabetes teams often provide highly coordinated care involving endocrinologists, diabetes educators, dietitians, psychologists, social workers, and parents or carers. Adult services generally expect greater independence and may have shorter appointments, different communication styles, and fewer dedicated transition resources. Without preparation, a young adult can miss reviews, run out of technology supplies, or delay seeking help during illness.
The risks are greatest when the transfer is treated as an administrative event. A warm handover, shared care plan, and clear explanation of who to contact can reduce gaps. The model should begin well before the final paediatric appointment and continue after the first adult visit, giving the young person time to build skills while trusted clinicians remain involved.
Research translation can support this process by connecting evidence with practical service design. Lessons from other fields, including the cancer immunotherapy pathway, show the value of coordinated pathways, defined responsibilities, and feedback between research and frontline care.
Designing A Model Around Real Life
A useful programme might include a transition readiness assessment, individual education goals, joint paediatric-adult clinics, telehealth appointments, and follow-up contact three and six months after transfer. Young adults should help decide the format, timing, and language of the programme. Some may prefer text reminders and online education, while others need face-to-face coaching or support involving a parent, partner, or carer.
Australian conditions must be built into the evaluation. The National Diabetes Services Scheme can help with access to diabetes products, while Medicare and private health arrangements influence appointments, psychology support, and technology costs. A participant studying in Brisbane may have reliable public transport and specialist access, whereas someone in Mount Isa, Toowoomba, or a remote community may depend on telehealth, visiting services, local general practice, and careful supply planning.
Cultural safety also matters. Services should work with Aboriginal and Torres Strait Islander health workers and local communities to ensure the model respects family structures, communication preferences, community obligations, and the realities of travel. Young people from culturally and linguistically diverse families may need interpreters or translated resources, while clinicians should avoid assuming that every family understands terms such as carbohydrate counting, continuous glucose monitoring, or ketone management.
Measuring Safety, Capability, And Experience
The evaluation should combine clinical data with outcomes that show whether the model helps a young person manage everyday life. HbA1c and diabetes-related hospital presentations remain important, but they cannot explain why care succeeds or fails. Measures should be collected at baseline, at transfer, and during follow-up so that changes can be linked to the programme.
Core Outcome Domains
- Glycaemic outcomes, severe hypoglycaemia, diabetic ketoacidosis, and emergency presentations
- Attendance at adult diabetes reviews and continuity with primary care
- Confidence with insulin dosing, sick-day rules, prescriptions, and device use
- Quality of life, diabetes distress, wellbeing, and readiness for self-management
Patient-reported measures should be easy to complete on a mobile phone and available in accessible formats. Interviews and focus groups can reveal issues that numbers miss, such as embarrassment about injecting insulin at work, anxiety about overnight hypos, or difficulty storing supplies in shared accommodation.
Implementation Signals
- Percentage receiving a written transition plan and confirmed adult appointment
- Time between the final paediatric visit and first adult service contact
- Completion of medication, device, psychosocial, and education reviews
- Young person and family ratings of communication, respect, and coordination
A strong evaluation should also record reach and equity. Results can be compared by age, gender, location, Aboriginal and Torres Strait Islander identity, socioeconomic circumstances, language, and use of diabetes technology. This prevents an average result from hiding poorer access for young people who already face barriers.
Building Partnerships Around Young Adults
No single service can manage transition well in isolation. Paediatric and adult diabetes teams need agreed referral criteria, shared clinical information, escalation pathways, and protected time for case discussion. General practitioners, community pharmacies, school or university health services, youth mental health providers, and Aboriginal Community Controlled Health Organisations may all contribute to continuity.
Young adults should be involved as partners in governance rather than invited only to comment after decisions are made. A youth advisory group can review education materials, appointment systems, privacy arrangements, and digital communication. Parents and carers also need guidance about changing roles: support should remain available without preventing the young adult from developing independent skills.
Community organisations may offer useful insight into peer connection and practical support. A volunteer workforce perspective can inform thinking about how trained volunteers, peer mentors, or community navigators might complement clinical care without replacing qualified diabetes professionals. Any such role requires clear boundaries, supervision, confidentiality safeguards, and referral pathways for urgent concerns.
Turning Evidence Into Sustainable Practice
The evaluation should be designed with implementation in mind from the beginning. A pilot can test whether joint appointments, telehealth, text reminders, and structured education are workable in metropolitan and regional settings. Researchers can then examine fidelity: was the model delivered as intended, and what adaptations were needed for different services or communities?
Economic analysis is also relevant to Queensland health services. A model that reduces emergency presentations, missed appointments, and duplicated assessments may offer value even if it requires early investment in coordinators or digital systems. The analysis should include costs to families, such as travel, time away from work, accommodation, and data access.
Brisbane Diamantina Health Partners provides a useful setting for collaboration between researchers, universities, clinicians, health services, and communities. Through Brisbane Diamantina Health Partners, evidence can be connected with local priorities and translated into pathways that are practical for hospitals, primary care, and community services. Findings should be shared through publications, service feedback, education sessions, and plain-language resources for young people.
A successful transition is visible in the small details: the prescription is current, supplies arrive on time, the adult team knows the person’s history, and the young adult knows what to do when glucose levels rise or illness begins. Health services, researchers, young people, families, and community partners can evaluate these measures together and turn the evidence into safer, more confident diabetes care across Queensland.
