Perceptions and experiential strategies of alcohol use in emerging adults with type 1 diabetes: A qualitative study

BACKGROUND: Emerging adulthood is a transitional life stage marked by identity exploration and heightened vulnerability to risk behaviors, including alcohol consumption. While drinking is culturally widespread and socially normative, it may be particularly harmful for individuals with type 1 diabetes, jeopardizing glycemic stability and health. Little is known about how this population manages alcohol use in everyday life. Existing clinical guidelines and patient education provide broad, standardized advice, which does not reflect the highly individualized strategies emerging adults develop in practice, limiting effective self-management. AIM: To explore the experiences of alcohol use strategies among emerging adults (18-29 years) with type 1 diabetes in Andalusia (Spain), examining how they construct meanings concerning alcohol use and perceive its impact on diabetes management, in order to inform nursing practice. DESIGN: Qualitative, descriptive study situated within an interpretative paradigm. PARTICIPANTS: Purposive sampling, complemented by snowball recruitment, was used to recruit 71 emerging adults with type 1 diabetes (aged 18-29) from Andalusia (Spain) between February 2020 and April 2022. METHODS: Semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Data were analyzed inductively using Reflexive Thematic Analysis to identify perceptions, meanings, and strategies related to alcohol consumption. RESULTS: Almost all the participants (97.2%) had tried alcohol, and 80.3% continued to drink. Monthly drinking, typically one to three drinks per occasion, was the most common pattern. The participants described developmental shifts, moving from distilled spirits toward fermented beverages perceived as more manageable. Meanings attached to alcohol-positive, negative, or indifferent-shaped drink selection and intake. Alcohol use was often recognized as destabilizing glycemic levels, producing feelings of vulnerability and limitation, yet some participants showed indifference or prioritized social participation. To mitigate risks, the participants adopted individualized strategies beyond the drinking moment. These strategies, which extend beyond drinking, are overlapping, highly personalized, and not adequately represented in current clinical education or guidelines. CONCLUSION: Alcohol consumption is a common and socially embedded behavior among emerging adults with type 1 diabetes. The experiential strategies they describe provide nuanced understandings of how they balance social participation with risk management. Current clinical guidelines often provide broad recommendations, failing to capture the highly individualized strategies that are critical for safer self-management. Nursing practice should integrate these personalized strategies into harm-reduction counseling and diabetes education, not to encourage alcohol consumption, but to foster a more realistic, person-centered approach that supports informed decisions and minimizes health risks. REGISTRATION: Not applicable.