Young adults (YA) with type 1 diabetes (T1D) face significant clinical and psychosocial challenges, starting with the transition from pediatric and through the full emergence to adult care.1 Changes in living situation, demands of increased independence, competing responsibilities (eg, college attendance or transition to full-time work),2 prevalence of high-risk behaviors,3 and depression4 can all represent barriers to the management of T1D.5

A large portion of YA does not meet glycated hemoglobin (HbA1c) targets6,7 and is at particularly high risk of hospitalization for diabetes-related ketoacidosis,8 hypoglycemia,9 and diabetes-related morbidity.10 Furthermore, people with suboptimal T1D control early in the course of the disease have a prospectively higher risk of long-term complications11,12 and mortality.13 Longer intervals between appointments with adult endocrinologists, compared to pediatric clinics, and often limited support to navigate the intricacies of the health care system14 can contribute to the fragmentation of diabetes care at this critical juncture. Finally, the use of continuous glucose monitoring (CGM), which has beneficial effects on diabetes metrics,15,16 remains sparse in YA due to cost, lack of support with the approval process, and concerns related to body image.17 As a corollary, system-based strategies that augment access and adherence to CGM are being pursued as plausible means to improve diabetes endpoints.18

As evidenced through the COVID-19 pandemic, the adoption of telemedicine for the management of T1D was generally well-received and did not result in worsening of efficacy or safety end-points, when compared to traditional office visits,19 especially when coupled with remote digital monitoring.20 Specifically, telemedicine has been shown to increase clinic attendance21,22 and patient satisfaction23 and has the potential to provide more frequent touch-points in those YA with T1D who are well-versed with digital health platforms, while saving the commuting time and related costs.

A case manager (CM)-based approach has proven effective in reducing the frequency of hypoglycemia and hospitalization in adolescents24 and in lowering HbA1c in the geriatric population25; however, adding a care navigator to assist YA transferring from pediatric to adult endocrinology clinics did not uniformly modify medical outcomes across all studies, while it is successful in maintaining clinic attendance.26, 27, 28 Moreover, the impact of a CM has not been fully evaluated in YA with T1D who are followed in adult endocrinology clinics after the transition from pediatric care is complete.

LIFT-YA (leveraging intensive follow-up treatment in young adults) is a structured multidisciplinary quality improvement (QI) program that was developed in our specialized adult diabetes clinic with 3 main objectives: (1) identify and address clinical and/or social barriers to T1D self-management in YA, after establishing adult diabetes care, (2) harness frequent telehealth visits to facilitate clinic attendance, while collecting information on diabetes metrics and changes in CGM use, and (3) assess the impact of CM as a mediator of logistical barriers to care and liaison between YA and the clinical team members.

Here, we present the results of the LIFT-YA, discuss the merits and limitations of the program, and factors that may influence its scalability in academic and community diabetes clinics.