What question did this study set out to answer?

This project aims to analyze baseline characteristics and reasons for referral of young adults with type 1 diabetes seeking additional education and behavioral health support.

June 7, 2026

1990-P: Baseline Characteristics of Young Adults with Type 1 Diabetes Referred for Additional Education and Behavioral Health Support: A Quality Improvement Project

Key Points

This project aims to analyze baseline characteristics and reasons for referral of young adults with type 1 diabetes seeking additional education and behavioral health support.
Referral of young adults (18-35 years) with type 1 diabetes for enhanced education and behavioral health support in a tertiary clinic.
Data analysis included A1c levels, insurance type, use of continuous glucose monitoring and insulin pumps.
Study duration spanned 6 months, following 110 young adults referred for support.
Mean A1c was 8.5±2.3%, with 39% having A1c <7.0%, 41% 7.0-10%, and 20% >10%.
72% of referrals were for psychological support, 28% for educational, and 8% for case management.
Common reasons for referral included severe hypoglycemia/hyperglycemia, insulin adjustments, diabetes burnout, and mental health challenges.

Abstract

Introduction and Objective: Young adults (YA) with type 1 diabetes (T1D) face unique clinical and psychosocial challenges, while adult care often emphasizes glycemic outcomes, with shorter visits and limited psychosocial support. Diabetes education and behavioral health services are essential, but referral processes and patient characteristics in adult tertiary clinics are not well described. As part of a quality improvement initiative (QI), we examined baseline characteristics and reasons for referral among YA with T1D receiving additional, flexible education and behavioral health support. Methods: Clinicians in a tertiary adult diabetes clinic could refer YA (18-35 yo) with T1D for enhanced diabetes education and/or behavioral health support beyond usual care, delivered through a flexible, tailored model. Baseline data including A1c, insurance type, use of continuous glucose monitoring (CGM) and insulin pump, and reason for referral were analyzed. Results: Over a 6-month period, 110 YA with T1D (age 27±4.5 years, diabetes duration 14.8±9.1 years, 67% female, 31% public insured; 91% on CGM and 49% on pump) were referred for at least one additional educational (28%), psychological (72%) and/or case management support (8%). At referral, mean A1c was 8.5±2.3% (range 4.6-13.6%); 39% had A1c 7.0%, 41% had A1c 7.0-10% and 20% had A1c 10%. Reasons for referral for the educator were: recurrent episodes of severe hypoglycemia or hyperglycemia; insulin adjustments, support with technology, and disordered eating behaviors, while for behavioral health social workers were: diabetes burnout, fear of hypoglycemia, obsessive behaviors associated with diabetes management, and mental illness impacting diabetes management. Conclusion: In this QI project YA with T1D referred for supplemental support represent a clinically and psychosocially diverse population. These findings highlight the need for referral pathways that move beyond glycemic outcomes to address patient complexity. Disclosure E. Toschi: Consultant; Current; Vertex Pharmaceuticals Incorporated. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. K. Horahan: None. E.D. Gill: None. C. Morgera: None. S. Gatti: None. Funding Support provided by the Lillylulu Foundation and Steven M. and Joyce E. Tadler Charitable Trust to the Joslin Young Adult Program.

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