Navigating transition to adult care in youth-onset type 2 diabetes: Facilitators, Attitudes, Barriers, and Behaviors

Abstract

Introduction

Transitioning from pediatric to adult-centered diabetes care may be challenging, especially for young persons at risk for and with youth-onset type 2 diabetes (Y-T2D) who have a high disease burden and rapidly progressive disease. However, the scope of transition readiness, range of psychosocial factors, and perceived barriers among Y-T2D are understudied.

Objective

In Y-T2D attending an adult diabetes transition clinic, our objectives were to: (1) characterize attitudes towards transition readiness, (2) examine relationships among depressive and anxiety-related symptoms and transition readiness, and (3) identify perceived barriers and facilitators of diabetes self-care.

Methods

Transition readiness was assessed with the Endocrine Society “Self-assessment of Worries, Concerns, and Burdens Related to Diabetes and Preparation for Transitioning,” and mood symptoms with the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7) questionnaire. Logistic regression analyses evaluated the response to transition readiness by mood symptoms. Qualitative analysis identified themes of diabetes self-care in a subset of Y-T2D.

Results

Survey response rate was 89%; n=65, age: 19.6±2.0y (mean±SD), 85% Y-T2D, 15% prediabetes, 57% female, 78% Black, BMI: 38.0±8.2kg/m2, and hemoglobin A1c: 7.6±2.7%. Perceived challenges were reported in 95% of participants and 54% reported worrying about their future. Mild or greater depressive and anxiety-related symptoms were associated with higher odds of reporting social, emotional, and cognitive challenges. Stress, socioeconomic difficulties, and challenges with organizational cognitive functioning were reported barriers to diabetes self-care.

Conclusion

Mood symptoms and difficulties with organizational cognitive functioning were commonly reported in Y-T2D during the transitioning period. Interventions are needed to successfully address these psychosocial factors.

youth-onset type 2 diabetes, diabetes, transition readiness, depressive symptoms, anxiety-related symptoms

Accepted manuscripts

Accepted manuscripts are PDF versions of the author’s final manuscript, as accepted for publication by the journal but prior to copyediting or typesetting. They can be cited using the author(s), article title, journal title, year of online publication, and DOI. They will be replaced by the final typeset articles, which may therefore contain changes. The DOI will remain the same throughout.