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Can And and But be used at the beginning of a sentence in formal writing? State-of-being verbs take adjectives, not adverbs 15. This leads us to temporarily group the last pair of items together when they should be separate.
Between is not limited to relationships between two nouns 17. A final comma would make the separation between these long, bulky noun phrases a little easier to follow. Many sentences I’ve encountered are asymmetric and unbalanced because some items of the list are much longer than others and the last two items aren’t separated by a comma.
A comma between each pair of items in the list would put all items on equal standing regardless of length, would give each item its own slot between commas or bookending the list, would make the separation between items clear, and would make each list more symmetrical, balanced, and measured.
The problem with all of those lists is that the last and/or second-to-last item is much shorter than at least one other item in the list, leading our minds to group two separate items together because of their shortness and the lack of a comma separating them.
It’s true that “if needed” could be surrounded by commas, but this is not necessary. Thirteen adolescents aged 13–18 years with poorly controlled type 1 diabetes, 19 parents and 9 health-care professionals participated.