Thirty-one consensus statements on getting young people through transition

ISPAD, EASD and ADA convened a joint working group on the move from paediatric to adult diabetes services and reached consensus on 31 statements covering the whole continuum: pre-transfer, transfer and post-transfer. The method matters for how much weight to give it - evidence graded A or B was included automatically, while C and E grade statements went through a Delphi survey for validation, and the systematic review was supplemented with global survey data from clinicians, patients and caregivers.

Transition is where young adults with type 1 diabetes are lost. Unplanned healthcare use is high in this group and translates into premature morbidity and mortality, and the failure is structural rather than individual: a young person moves from a service that chased them to one that waits for them to book. The report's three-stage framing is the useful part, because it makes clear that preparation before transfer and follow-up after it are separate pieces of work, not the same conversation repeated.

The authors are explicit that this is a guide to be adapted locally. For an Indian service, where paediatric and adult diabetes care are often in different institutions and transfer can mean a change of city as well as of clinic, the post-transfer stage is where the pathway most often breaks: verify first attendance at the adult clinic rather than assuming the referral completed it.

• Audit your local pathway against the three stages; most services have a transfer but no pre- or post-transfer step.
• Name a person responsible for confirming the young person attended the first adult appointment.
• Start transition preparation well before the birthday that forces it.
• Ask directly about alcohol, contraception and driving - the adult conversations paediatric clinics often skip.
• Record a transition readiness assessment rather than relying on age alone to decide timing.

Why it matters

It treats transition as a defined clinical process with steps that can be audited, rather than an administrative handover nobody owns.

Don't overread it

A consensus report is expert agreement on how to organise care; it does not show that following it improves glycaemic or mortality outcomes.

The statistics, in plain English

Consensus reports are not trials and carry no effect size. The grading is the thing to read: statements resting on A or B evidence were adopted directly, while weaker C and E grade statements needed expert agreement through a Delphi process - meaning much of the detail reflects expert opinion, which is appropriate for a service-design question no trial has answered.

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