Aim: To examine challenges contributing to disruptions in care during the transition from paediatric to adult care among young adults with Type 1 diabetes who are primarily in ethnic minority groups and have low socio‐economic status.Methods: Participants (n = 20) were newly enrolled patients in a transition clinic for young adults with Type 1 diabetes with a history of loss to medical follow‐up. Participants completed qualitative semi‐structured interviews detailing their transition experiences in addition to demographic, HbA_1c and psychosocial measures. Descriptive statistics were completed for quantitative data, and narrative thematic analysis of interviews was used to identify common themes. A mixed‐method analysis was used to identify the associations between stressors identified in interviews and clinical and psychosocial variables.Results: Three categories of challenges contributing to loss to follow‐up were identified: psychosocial challenges, health provider and health system challenges and developmental challenges. Participants experienced a high degree of stressful life circumstances which were associated with higher HbA_1c (r = 0.60, P = 0.005), longer duration of loss to follow‐up (r = 0.51, P = 0.02), greater emergency department utilization (r = 0.45, P = 0.05), and lower life satisfaction (r = ‐0.62, P = 0.003).Conclusions: A confluence of challenges, including stressful life circumstances, healthcare system barriers and the developmental trajectory of young adulthood, contributes to a high risk of loss to follow‐up and poor health in this population of young adults with Type 1 diabetes. An integrated approach to transition addressing medical and psychosocial needs may facilitate improved follow‐up and health outcomes in clinical settings.

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