Abstract Aims To systematically review and synthesise findings from qualitative studies regarding the transition process and transfer from paediatric to adult diabetes care, including perceived strengths and limitations of transition practices. Synthesising qualitative evidence from key stakeholders offers an opportunity to better understand how transition readiness is experienced, how it may influence engagement and outcomes, and why transition programs vary in effectiveness across settings. Methods Qualitative evidence synthesis was completed of the diabetes transition process with articles published in English between 2018 and 2023, which is in line with our previously published quantitative systematic review. Studies were systematically identified and screened by searching six databases and PRISMA criteria were used. Search terms included the following MESH headings and keywords: (type 1 diabetes OR type 2 diabetes OR diabetes mellitus) AND (transfer to adult care OR transition to adult care OR transition readiness). Risk of bias and quality assessments were performed using the Critical Appraisal Skills Programme. Both the strengths of weaknesses of each transition programme were extracted, as well as data integration across studies using a thematic synthesis approach. Results In total, 15 publications were included of which two‐thirds were from North America. Data were obtained from patients, parents/caregivers and healthcare professionals, using semi‐structured interviews, surveys and focus groups, covering the full transition period. Three key themes were identified: (1) Expectation of greater autonomy/independence for the person with diabetes (PWD), (2) Loss of paediatric provider and insecurity about new healthcare provider (HCP), and (3) Lack of formal preparation for the transition from paediatrics to adult care. Perceived strengths and weaknesses of the different transition programmes underscore the need for a proactive approach, supporting a smooth transfer and facilitating the young person's independence and self‐management capacity. Conclusions This systematic review of qualitative studies highlights the need to address the unique challenges of adolescents and young adults when transferred from paediatric to adult diabetes care and improve quality transition programmes. A smooth transition process demands a personalised approach from HCPs and system‐level coordination across care teams is essential for supporting successful engagement within adult diabetes care.
Abstract Aims Type 1 diabetes results from autoimmune destruction of insulin‐producing pancreatic β‐cells. Although exogenous insulin remains the standard treatment, it does not restore physiological glucose regulation. Differentiation of human pluripotent stem cells into β‐cells offers a scalable alternative to cadaveric islet transplantation and has progressed rapidly over the past decade, resulting in nine clinical trials at various stages of completion. Despite this progress, durable graft function remains constrained by two major challenges: the absence of key islet microenvironment components, such as vasculature, extracellular matrix and supporting cell types and continued vulnerability to autoimmune and alloimmune rejection. Methods & Results This review considers emerging technological approaches to overcome these barriers. Bioengineered niches, including multilineage organoids, functionalized hydrogels, decellularized matrices and bioprinting, aim to recreate the native islet microenvironment, while synthetic biology approaches, such as hypoimmune gene editing, CRISPR‐based transcriptional control and stimulus‐responsive survival circuits, seek to enhance grafts' resilience. Computational and single‐cell approaches, including gene regulatory network analysis and digital twin frameworks, are beginning to provide predictive tools for benchmarking differentiation quality and forecasting graft outcomes. Conclusion Together, these complementary strategies, potentially tailored to individual patients, represent a realistic path towards safer, more effective and durable β‐cell replacement therapies for type 1 diabetes.
Abstract Background Type 1 diabetes progresses through presymptomatic early stages defined by islet autoantibody positivity and glycaemia. Early detection reduces ketoacidosis and facilitates access to disease‐modifying therapies. The extent to which autoantibody screening and follow‐up have been adopted in UK clinical practice for adults is uncertain. Methods We conducted a web‐based survey of members of the Association of British Clinical Diabetologists (ABCD), Diabetes Technology Network UK (DTN‐UK) and Primary Care Diabetes and Obesity Society (PCDOS) between 12 December 2025 and 2 February 2026. Results Of 164 complete responses, 116 (71%) were from doctors, 40 (24%) from nurses and 8 (5%) from other healthcare professionals. The majority were from district general hospitals ( n = 91, 56%), followed by tertiary centres ( n = 31, 19%), community‐based and private specialist diabetes services ( n = 14, 9%) and general practice ( n = 28, 17%). Thirty‐five per cent (11/31) in tertiary centres and 21% (22/105) in other care settings reported experience in managing adults with early‐stage T1D. Among these clinicians, HbA1c was the most commonly used follow‐up method (73% in tertiary centres and 86% in other settings), while approximately half offered capillary blood glucose and ketone meters and/or continuous glucose monitoring. In general practice, access to islet autoantibody testing was limited, and few had local guidelines for managing stage 1 or 2 T1D. In diabetes specialist practice, autoantibodies to GAD, IA‐2 and ZnT8, but not insulin, were the most widely requested islet autoantibody assays. Perceived readiness to implement immunotherapy was low across all settings. Conclusions Early‐stage T1D management is evolving within UK clinical practice. Monitoring and management practices broadly align with consensus recommendations. Education, national guidance and clear commissioning frameworks will be essential for successful provision of immunotherapies.
Abstract Aims Diabetes distress affects about one‐third of adults with diabetes and is associated with poorer health outcomes, yet routine screening by healthcare professionals remains uncommon. This study examined person‐reported experiences of emotional health screening across a large Australian sample. Methods Adults with diabetes completed an online cross‐sectional survey involving emotional health screening and assessing whether their diabetes healthcare provider had ever asked about their diabetes‐related emotional health. Participant characteristics were compared by ‘asked’ status. A pre‐specified multivariable logistic regression identified demographic and clinical predictors of never being asked. Open text responses were analysed using inductive thematic analysis. Results Of the 1092 eligible respondents (median age 57 years [IQR 44–67]; n = 676 women [62%]; diabetes duration 10 years [4–21]; n = 274 [25%] with type 1 diabetes; n = 391 [36%] using continuous glucose monitoring [CGM]), most ( n = 797; 73%) reported never being asked about their diabetes‐related emotional health by their diabetes healthcare provider. Approximately 42% screened positive for diabetes distress (PAID‐5 ≥ 8), with similar prevalence irrespective of ‘asked’ status. CGM use was the strongest predictor of being asked about emotional health, with CGM non‐users having nearly double the odds of never being asked (OR = 2.00, 95% CI 1.19–3.33, p = 0.007). Seven qualitative themes emerged, highlighting the emotional burden of diabetes, inconsistent care and participants' desire to be asked about emotional wellbeing. Conclusions Most adults with diabetes in Australia are not asked about their emotional health, despite guideline recommendations. Elevated distress is common yet under‐identified. Systemic changes are needed to close this gap.
Abstract Aims Type 1 diabetes (T1D) is a self‐driving autoimmune condition leading to the death of insulin‐producing β‐cells of the pancreas. β‐cell‐reactive immune cell extravasation into the intra‐islet space is fuelled by a cycle of inflammation including immune, vascular and endocrine dysfunction. Since clinical pancreatic biopsy is contraindicated, T1D research relies on static in vitro culture or in vivo models that either cannot fully replicate the dynamic interactions between the three different tissue types or differ greatly from the human disease process. Methods Recent advances in bioengineering have led to the emergence of Organ‐on‐Chip (OoC) platforms that aim to recapitulate the human diabetic pancreatic environment. Early T1D‐relevant OoC‐based research focused on the assessment of islet viability. This review turns its attention to the next frontier of vascularised and immune‐competent PoC models, which hold promise for the study of the insulitis of T1D and to predict treatment response to novel therapies. Results PoC models can incorporate technologies developed for cancer and non‐diabetes inflammation applications to inform chip design, vascularisation, immune perfusion and pancreatic component incorporation. An established PoC model can then be utilised for a detailed quantitative and qualitative analysis and functional correlation of the immune, vascular and pancreatic components according to an a priori Context of Use (CoU). Conclusion The ease of manufacturing, combined with a future possibility of a fully human autologous PoC, could enable high‐throughput screening of T1D tissue for underlying causes of patient heterogeneity that, in turn, could inform personalised treatment approaches, prolonged cell therapy survival and novel preventative measures.
