Table 2

Representative quotations from thematic analysis of narrative comments

Intensive time and care coordination requirements of young adults with type 1 diabetes“I always plan on running behind with this group.” “I often spend more time on social issues than actual medical decision-making.” “It takes a great deal of time…I wish I had more resources to deal with the transition of adolescents/young adults to the adult endo clinic.” “Very time-consuming and intense, requires coordination of care, family interaction and involvement, utilizes many resources.”
Challenges with nonadherence among young adults with type 1 diabetes“I find it frustrating at times because they do not yet realize the potential severity of their disease. They no-show for appointments at much higher rate than other adult patients.” “Young adults are generally noncompliant and don't take their diagnoses seriously. There are very few young adults I see that are motivated to care about their disease. This is the biggest challenge.” “They fall in two camps...very committed to their care, in which taking care of them is easy, and very negligent/irresponsible when it comes to managing which case I don't know how to help them.” “Young adults with type 1 diabetes have many competing demands which puts their diabetes care last on their priorities…many are unprepared about the differences between pediatric and adult care or even how to function as an independent young adult with type 1 diabetes.”
Divergent approaches to care by pediatric and adult diabetes providers“Almost none of these young adults arrive in my office with the ability to care for their diabetes on their own. I have a sense that they learned nothing from their pediatric endocrinologists or they were taught nothing.” “Generally ill-prepared to face responsibilities as adult diabetic patient. Are coddled too long by parents and pediatric practices. Adult practices in non-academic environments cannot ‘hold hands.’ These young adults are not trained to be accountable for their actions and have difficulty transitioning to adult care.” “Overall I've been underwhelmed by pediatric endocrinologists from what the patients transitioning to me tell me. It seems that A1Cs are not stressed and avoidance of hypoglycemia is stressed excessively…I then get patients that are developing complications in their mid-20’s.” “Patients transitioning from peds have been conditioned to think an A1C of 8 is OK. Then the adult endo becomes the bad news doctor, making the transition worse.”