Transitioning to adult care in youth-onset diabetes: a scoping review of socio-ecological factors in youth-onset type 2 diabetes compared to type 1 diabetes

Abstract

Background: Multiple socio-cultural and personal factors influence the transition from pediatric to adult-centered diabetes care in youth-onset type 1 diabetes (Y-T1D), but few data exist in youth-onset type 2 diabetes (Y-T2D). We determined the scope of the literature on socio-ecological factors associated with transitioning to adult care in Y-T2D compared with Y- T1D to identify facilitators, barriers, and knowledge gaps in Y-T2D. Method: We conducted a global scoping review using the Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR) guidelines. Eligible articles were peer-reviewed experimental and quasi-experimental articles published between January 1990 and September 2022, with no language restrictions. Results: In 104 articles that reported on transitioning to adult care, 88% were in Y-T1D, 6% compared Y-T1D and Y-T2D, 2% reported in Y-T2D only, and 4% reported on youth-onset diabetes diagnosis. The proportion of articles that reported on socio-ecological domains were similar in Y-T1D compared to articles that included Y-T2D. Identified challenges associated with the transitioning period in Y-T2D were societal (structural bias, poverty, inadequate social support), health cultural (limited access to adult health-care providers), psychological (feelings of anxiety and fear of transition), and behavioral (difficulty with medication adherence). The transition period was associated with worsening glycemic control in both groups. Conclusions: Y-T2D face multiple challenges across socio-ecological domains during the transition to adult-centered diabetes care. However, only 8% of studies on transitioning factors included Y-T2D and additional research is needed to develop dynamic and robust transition programs in Y-T2D. Scoping review registration: Protocol was registered with Open Science Framework, April 4, 2022. https://osf.io/k2pwc.