Making T1D fit in the life of young adults
Anka van Gastel, Matthijs Graner-Baars, Eelco J.P. de Koning, Victor M. Montori, Viet-Thi Tran, Sean F. Dinneen, Jessica Mesman, Joris Swaak, Henk-Jan Aanstoot, Anne M. Stiggelbout, Marleen Kunnema
EPicture living with diabetes: A photovoice study of young adults' efforts in making diabetes care fit into their lives. Diabet Med. 2026 Feb 5:e70246.
Young adults with type 1 diabetes (T1D) face a uniquely challenging life stage. Alongside intensive daily self-management, they navigate major transitions such as education, work, relationships, and increasing independence. Despite advances in diabetes technology, glycaemic outcomes in this group remain suboptimal, and treatment burden and diabetes distress are relatively high. To improve care, it is essential to better understand how young adults actually integrate diabetes into their daily lives. However, much of this experience remains invisible in routine clinical encounters. This study therefore aimed to explore how young adults with T1D make diabetes care fit into their lives, and what impact this has on their daily living.
This qualitative study used a photovoice approach, in which young adults (18–30 years) with T1D captured real-life situations through photographs. Participants submitted 240 photos illustrating both their efforts to manage diabetes and its impact on daily life, which were further explored through interviews, questionnaires, and focus groups. Participants themselves identified themes, which were iteratively refined with researchers into four overarching categories: 1) My diabetes, 2) My life, 3) Support, 4) Mental aspects. These categories reflect the complex and interconnected realities of living with T1D.
Key POINTS:
- Young adults experience diabetes as a continuous, 24/7 presence, requiring constant monitoring, decision-making, and adjustment.
- Diabetes care must be continuously balanced with the flow and unpredictability of daily life, including work, social activities, and life transitions.
- Support systems—such as technology, healthcare professionals, and social networks—can both help and create additional burden.
- Mental health emerged as a central, cross-cutting theme, influencing and being influenced by all other aspects of living with diabetes.
- Much of the effort required to manage diabetes remains largely invisible to clinicians, unless explicitly discussed.
This study highlights that managing type 1 diabetes is not simply about achieving glycaemic targets, but about continuously negotiating how care fits within a meaningful life. For young adults, this often involves trade-offs between optimal glucose control and participation in everyday activities. The findings emphasise the need for person-centred and flexible care approaches that take into account the realities of daily life, rather than focusing solely on biomedical outcomes. In particular, more attention is needed for mental health, life context, and the cumulative burden of ongoing decision-making. Importantly, the study also suggests that creating space for conversations about lived experience—potentially supported by innovative methods such as photovoice—may help bridge the gap between clinical care and daily life.
Concluding, the authors state
"Young adults with T1D face the ongoing challenge of managing complex care tasks and glycemic targets within the ever-changing rhythm of daily life." -
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