By Nadine Salmon, BSN, IBCLC, Clinical Content Specialist, AMN Healthcare
According to the National Diabetes Education Program (NDEP, 2012), there are about 215,000 young Americans (20 and younger), who have diabetes. Although a majority from this group have type 1 diabetes, (formerly known as juvenile diabetes), type 2 diabetes is becoming increasingly prevalent in the young adult population. Historically, type 2 diabetes has been most typically diagnosed in older adults, 45 years and older. However, with the recent obesity epidemic, type 2 diabetes is becoming more common than ever in younger people; children with BMI measuring at >85th percentile are at increased risk for developing type 2 diabetes (NDEP, 2012).
It’s already tough enough to be a teenager; add diabetes to the mix and it becomes a daunting challenge. Hormonal and psychosocial changes during puberty can seriously complicate diabetes regulation. Researchers have found that adolescents with type 1 diabetes typically display the worst glycemic control compared with other age groups (Craig et al., 2002 in De Wit et al., 2008). From a developmental perspective, the daily demands of self-regulation can interfere with adolescents’ normal routines and friendships, thereby compromising their emotional and social well-being (De Wit et al., 2008). Moreover, teenagers tend to give high priority to fulfilling their psychosocial needs in the here and now, rather than taking preventive action to avoid health risks long term. Teenagers may also lack the awareness of the effects of alcohol and recreational drugs on blood sugar levels and partake in risky lifestyle choices without fully realizing the unique health challenges facing them.
Family dynamics have also been shown to have an impact on diabetes management in adolescents (Solowiejczyk, 2004). Diabetes is a chronic disease that requires constant vigilance and monitoring by the patient and family to achieve optimal control of blood glucose levels. Although physicians, nurses, dietitians and other healthcare providers are important sources of information, expertise and support, it is the teenager and his/her parents who are ultimately responsible for maintaining acceptable hemoglobin (A1C) results (Solowiejczyk, 2004). Healthcare professionals and parents are tasked with a daunting challenge: To instill a sense of confidence, competence, and independence in their teen, without losing sight of the fact that they are not yet adults (Solowiejczyk, 2004). Helping children and families achieve a sense of balance, (in which neither metabolic control nor quality of life is compromised), is something all health care professionals strive to accomplish (Solowiejczyk, 2004).
The Family Approach to Diabetes Management (FADM) is a theoretical model that stresses patient and family self-management by identifying and exploring patterns of family communication that hinder or support positive clinical outcomes (Solowiejczyk, 2004). Parents are encouraged to actively promote compliance in their teen by enforcing strict diabetic monitoring, and actively removing certain privileges from the teenager if compliance is poor. This may entail limiting cell phone use or computer privileges until diabetes management is conducted in a sensible, responsible and continuous manner. The FADM supports parents in their effort to be firm, consistent and supportive, but not rigid in their approach to dealing with diabetes compliance. The goal of the approach is to help families organize themselves in such a way that adolescents feel supported in their diabetes management efforts. This supportive family atmosphere is crucial to achieving optimal metabolic control in teens (Solowiejczyk, 2004).
This approach is the antithesis of the traditional approach to managing irresponsible teenagers, in which parents are asked to step-down and give adolescents more room and accountability. When dealing with diabetic teens, parents must provide a sense of structure and clear, consistent boundaries. It is essential that teens learn to take control of their own health, so that they are able to manage their disease responsibly (Solowiejczyk, 2004).
Healthcare professionals can support families dealing with diabetes by referring them to the numerous free online resources available at the American Diabetes Association. Check out some available resources to share with your patients at: Diabetes Pro®. RN.com also offers several continuing education courses on diabetes at www.rn.com.
De Wit, M., Van De Waal, H., Alle Bokma, J., Haasnoot, K., Houdijk, M., Gemke, R. & Snoek, F. (2008). Monitoring and Discussing Health-Related Quality of Life in Adolescents with Type 1 Diabetes. Diabetes Care, 31 (8), P. 1521-1526.
National Diabetes Association. (2012). Diabetes Pro: Resources for Professionals. Retrieved from http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=60378&typ=17
National Diabetes Education Program [NDEP]. (2012). Guiding Principles for Diabetes Care: For Health Care Professionals. Retrieved from http://www.ndep.nih.gov/media/GuidPrin_HC_Eng.pdf
Solowiejczyk, J. (2004). The Family Approach to Diabetes Management: Theory into Practice Toward the Development of a New Paradigm. Diabetes Spectrum, 17 (1), P. 31-36. Retrieved from http://spectrum.diabetesjournals.org/content/17/1/31.full
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