Young Adults With Diabetes

Need for a new treatment paradigm

The results of the study reported by Bryden and et al. (1) in this issue of Diabetes Care present a sobering perspective on the challenges and lost opportunities faced during the transition of adolescents with diabetes to early adulthood. As highlighted by these findings, young adults with diabetes are a forgotten group, whose special needs seem to fall outside the primary focus of both pediatric and adult medicine (2). Many challenges are confronted at this critical transition when young adults take over the responsibility for their own self-care (3). The adult medicine culture is generally less forgiving of the behavioral and developmental struggles of the patient, and this can be unsettling to some young adults. In addition, many parents are unnerved by the, often abrupt, change in their role when their child “graduates” from the care of the more family-focused pediatric environment. The overwhelming changes in the first phase of the young-adult period (including graduating from high school, moving away from home, beginning new educational directions, and beginning to work and to be self-supporting) are often a distraction from the demands of managing diabetes. However, later, the developmental focus shifts toward making choices and plans about relationships, work directions, and lifestyle behaviors. This second phase of the young-adult period, when the life-long routines of self-care are set, can present a window of opportunity for the provider to intervene and to influence habits that will help to …