DIABETICMedicine DOI: 10.1111/j.1464-5491.2008.02647.x © 2009 The Authors. 162 Journal compilation © 2009 Diabetes UK. Diabetic Medicine, 26, 162–166 Blackwell Publishing Ltd Original Article: Care Delivery The transition from children’s to adult diabetes services: understanding the ‘problem’ D. Allen and J. Gregory* Nursing and Midwifery Studies and *Child Health, Cardiff University, Cardiff, UK Accepted 21 November 2008 Abstract Aims The importance of getting transition right for young people with diabetes is increasingly recognized and a strong professional consensus has emerged on best practice in this domain. Research evidence to inform the design of transitional healthcare services is weak, however, and prevailing views about ‘the problem of transition’ are based on a number of assumptions about adolescence, adulthood and chronic disease management which have been accepted uncritically. Methods Drawing on youth studies and the sociology of chronic disease management, in this paper we describe how ‘the problem of transition’ has been defined in the professional and UK policy literature and examine the assumptions that underpin it. Results We argue that the overwhelming emphasis is on how best to support young people in fitting in with the healthcare system. This has produced an orientation which is more concerned with supporting young people in the process of becoming adults rather than giving attention to their contemporaneous experiences and needs. Two years after the introduction of the UK National Service Framework for diabetes, the challenge of transitional services remains. Conclusions We suggest that the time has come to consider alternative formulations of the ‘problem’. Rather than asking how best to manage transition, we might ask how best to meet the needs of young people with diabetes at this stage of the life course. This requires an understanding of their experiences, the social networks in which they are embedded and consideration of how self-management might be supported by the healthcare system. Diabet. Med. 26, 162–166 (2009) Keywords service provision, teenagers Introduction Type 1 diabetes is a lifelong condition which requires continuous self-management. During the teenage years, many experience deterioration in glycaemic control and they are particularly vulnerable as their care is transferred from child to adult services. The importance of getting transition right for young people with diabetes is increasingly acknowledged across the international healthcare arena, reflecting a growing recogni- tion that this group sits uncomfortably within existing service structures. All too often transition has been perceived as a single event and there has been a lack of appreciation of the need for developmentally appropriate services [1]. Since transition first became an acknowledged health policy concern over 20 years ago, a strong professional consensus has emerged on best practice in this domain and numerous guidelines now exist [2]. Research evidence to inform the design of transitional healthcare services is weak [3], however, and prevailing views about ‘the problem of transition’ are based on assumptions about adolescence, adulthood and chronic disease management which have been accepted uncritically. In this paper we describe how ‘the problem of transition’ has been defined in the professional and UK policy literature and examine the assump- tions that underpin it. The paper is not intended to present an exhaustive review of this field; our aim is to identify the main characteristics of the dominant discourse which has shaped thinking in this area of diabetes care. The notion of discourse is taken from the social sciences and refers to ways of organizing Correspondence to: Davina Allen, School of Nursing and Midwifery Studies, Cardiff University, 4th Floor East Gate House, 35-43 Newport Road, Cardiff, CF24 0AB, UK, Cardiff University, Cardiff, UK. E-mail: allenda@cf.ac.uk