Academic journal article American Journal of Health Education

Psychosocial Issues That Affect Youth with Diabetes

Academic journal article American Journal of Health Education

Psychosocial Issues That Affect Youth with Diabetes

Article excerpt

ABSTRACT

Type 1 diabetes, one of the most common diseases of childhood, requires adherence to a complicated regimen which is often times difficult to manage resulting in stress for children, siblings, and caregivers. Many children with diabetes are nonadherent, likely due to the difficulty and complexity of the tasks required, and, thus, are at greater risk for diabetes related complications. For health care educators, it is important to understand the various psychosocial issues that affect adherence and adjustment to diabetes. This article will discuss these issues, including coping with a new diagnosis, school factors, regimen adherence and family variable and parenting strategies. Recommendations for health care educators are also discussed.

INTRODUCTION

Type 1 diabetes (T1D) is a difficult and taxing disease for children and adolescents. It requires the family to balance challenging medical tasks (e.g., blood glucose monitoring, multiple daily insulin injections, dose calculations, advanced level of problem solving or decision making) with dietary modification and exercise into already complex daily lives to maintain stable blood glucose levels to prevent complications to growth and development. Considering the level of difficulty, it is not surprising that 50% to 55% of youth are nonadherent and as many as 30% to 50% of youth with T1D are in poor glycemic control. (1) As a result, these children face severe health complications such as increased risk for diabetic ketoacidosis (DKA), damage to major organ systems and premature death. (1-3) In addition to the direct consequences, nonadherence may impact clinical decisions made by health care providers, such as increasing insulin doses for high blood glucose levels when, in fact, high glucose concentrations are due to failure to follow the diabetes regimen. Further, poor adherence results in medication abuse and excessive use of health care services. (4,5)

Understanding factors associated with adjustment and adherence is important for anyone working with children and adolescents with diabetes, as better adherence may translate to improved glycemic control. (6) Adherence to the diabetes regimen is influenced by many factors, such as initial adjustment and acceptance of the illness as well as coping with behavioral, school and family stressors. Given the severity of complications resulting from poor glycemic control, health educators must be knowledgeable about these various psychosocial factors in order to help identify youth at risk for poor adjustment to their diabetes and to guide strategies aimed at improving regimen adherence.

COPING WITH A NEW DIAGNOSIS

Diabetes is one of the most common chronic illnesses of childhood with more than 13,000 new diagnoses occurring each year. (7) A diagnosis of type 1 diabetes elicits a number of emotions and grief reactions including anger, sadness, guilt and anxiety which typically resolve within the first year. (8) Psychosocial acceptance and adaptation to the illness can impact long term adjustment for both children with diabetes and their families.

When a child is diagnosed with diabetes, parents must learn a large amount of new information and many new skills to care for their child adequately, while experiencing a wide range of emotions, including shock, grief and guilt. Parents often attempt to cope with the diagnosis using a variety of strategies that may be helpful or may interfere with the child's ability to cope. (9) Some parents have difficulty accepting the information and cope by denying that their lives will change or that diabetes will affect them. (10) Other parents respond with anxiety and attempt to control more aspects of the child's life. After time, parents may find a healthy balance between being involved in their child's care and allowing freedom to be a child. It is important to help parents to establish realistic expectations about management of diabetes, financial costs, reasonable glycemic control and methods for treating hypoglycemia. …

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