A joint working group of the International Society for Pediatric and Adolescent Diabetes, the European Association for the Study of Diabetes and the American Diabetes Association produced a consensus report on the move from paediatric to adult diabetes services. It follows ACCORD and AGREE II methods: existing recommendations and toolkits were reviewed, current evidence systematically searched, and global surveys of clinicians, patients and carers added as primary data. Statements resting on grade A or B evidence were included directly; those on grade C or E evidence went through a Delphi survey. Thirty-one statements reached consensus, organised across three stages — pre-transfer, transfer and post-transfer.
The reason this is worth a diabetologist's attention is the loss rate. Young adulthood carries high rates of unplanned health care use and a measurable excess of premature morbidity and mortality, and the point people fall out of care is the handover. Most services treat transfer as an administrative event — a letter, a first adult clinic appointment — and the consensus treats it as a continuum with work to do on either side of the transfer date.
It explicitly asks to be adapted locally, which matters in India, where paediatric and adult diabetes services are often in different institutions and the young person may be paying for their own care for the first time. The structure of the three stages is portable even where the specific service models are not.
- Name the transfer date well in advance and check readiness before it, not at the first adult appointment.
- Make one person accountable for confirming the young adult actually attended the adult clinic.
- Ask about cost and who is now paying for strips, sensors and insulin — this is when supply quietly stops.
- Screen for diabetes distress and mental health at transfer; the consensus treats it as part of the process, not an add-on.
- Record a post-transfer check at three to six months as a standing item.
Why it matters
The point at which young adults disappear from diabetes care is a handover most services record as complete.
Don't overread it
A consensus report is expert agreement structured by a Delphi process, not trial evidence that following it lowers mortality.
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