OBJECTIVES: To determine whether a systems navigator service, The Maestro Project, could increase medical surveillance for young adults with type 1 diabetes who transfer from pediatric to adult care. RESEARCH DESIGN AND METHODS: There were two cohorts of participants: 1) a younger group (aged 18 years, n = 82) who had the assistance of the navigator as they graduated from pediatric care and 2) an older group (aged 19-25 years) who were transferred to adult care without this initial support but later enrolled in the program. RESULTS: Of the older group (who did not have initial access to the navigator), 40% dropped out of adult medical care, compared with a dropout rate of 11% for the younger group, who had access to the navigator at the time of transfer from pediatric care. CONCLUSIONS: The systems navigator helped improve medical surveillance for both groups, although there was no evidence of improved short-term medical outcomes.