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.

Keywords: anxiety-related symptoms; depressive symptoms; diabetes; transition readiness; youth-onset type 2 diabetes.