Life stage transitions for people with type 1 diabetes

Type 1 diabetes affects individuals of all ages, with different clinical priorities and support needs at different stages of life. In this Personal View, we define the two major transitions that occur across the lifespan in type 1 diabetes: the emerging adult transition (typically occurring between age 18 years and age 25 years, as individuals transition to self-management and transfer to adult care), and the older adult transition (occurring at variable ages as individuals develop comorbidities and complications that could require increased assistance with management and customisation of glycaemic targets). We identify a framework considering these life stage transitions, including eight domains common to both stages. These domains include the following: needs from the medical care team, diabetes self-management education and support needs, adapting diabetes management to evolving physiology, comorbidities affecting self-care and diabetes management, changing neurocognitive physiology and self-management capabilities, functional status and activity levels, degrees of independence (living situations and social support), and changing financial context. We discuss key clinical gaps and research needs, focusing on how the similarities in these major transitions can be leveraged to improve care for people with type 1 diabetes across the lifespan.