Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study

Diabetes Educ. 2014 Jan-Feb;40(1):40-7. doi: 10.1177/0145721713513177. Epub 2013 Nov 20.


Purpose: The purpose of this study was to explore perceptions that emerging adults with type 1 diabetes (T1D) have of their patient-provider relationships across the transition from pediatric to adult care.

Methods: Twenty-six emerging adults with T1D (mean age 26.2 ± 2.5 years) participated in 5 focus groups stratified by current level of glycemic control (A1C). Coded audio-recorded data were analyzed using thematic analysis and aided by NVivo software.

Results: Three major themes emerged from the analysis: (1) loss and gain in provider relationships across the transition-patients expressed 3 key responses to leaving pediatric providers that differed by A1C levels: sad reluctance and "natural progression" (mean A1C ± SD 7.4% ± 0.6%) and wanting to go (mean A1C ± SD 9.8% ± 1.0%); (2) partners in care versus on one's own-patients valued how adult providers' collaborative conversations promoted their involvement and accountability compared to "parent-centric" interactions with pediatric providers, but they also expressed ambivalence over increased independence in adult care; (3) improving provider approaches to transition-patients recommended that pediatric providers actively promote emerging adults' autonomy while maintaining parental support, communication with adult providers, and follow-up with transitioning patients.

Conclusions: Findings highlight the importance of enhanced provider awareness of T1D emerging adults' complex feelings about the transition in care. Improved integration of individual- and family-centered approaches to developmentally tailored diabetes care is needed to augment patient and provider relationships.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Blood Glucose / metabolism*
  • Communication*
  • Diabetes Mellitus, Type 1 / psychology*
  • Diabetes Mellitus, Type 1 / therapy
  • Emotions
  • Female
  • Focus Groups
  • Glycated Hemoglobin A / metabolism*
  • Humans
  • Male
  • Patient Satisfaction
  • Perception
  • Qualitative Research
  • Software
  • Transition to Adult Care*


  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human