Type 2 diabetes in children and adolescents is a growing phenomenon and a scary one. Complications can be linked to duration of diabetes and these young people still have a long time ahead of them when they are diagnosed aged under 18. Making their life with diabetes a healthy one is the great challenge, and this can only happen with their full knowledge and participation. Fortunately, research published this month in the respected journal 'Diabetic Medicine' gives some practical and important pointers as to how to achieve this.
The researchers asked adolescents with Type 2 diabetes directly about their beliefs, experiences, wishes and needs in relation to their condition and gained some important insights. For example, that the young people generally were not willing to tell their peers about their condition, for fear of judgement and bullying; that they wanted medications that were discreet and effective (tablets better than injections; injections of non-insulin products rather than insulin, because of their perception of its relationship with severity of diabetes and insulin leading to weight gain); that they would seriously consider bariatric surgery for weight loss. They also seemed to lack support from others, e.g. family members, when they would value reminders to help take medication and sharing in lifestyle changes.
One of the most striking findings was that the young people in the study did not seem to be overly concerned about their Type 2 diabetes or particularly aware of its progress or prognosis. Some of this seemed to originate with the familiarity of the condition through other family members having it, so it seemed 'normal' for them to be also diagnosed. Also, where family members did not make lifestyle or food changes, it was very difficult for them to do this on their own or see the importance of this. On the other hand, could some also be explained by them not receiving this information or it being emphasised enough during their care encounters with professionals?
Professionals are only just coming across such young people with Type 2 diabetes and there are few in any single clinic. Hence it may well be that they need particular guidance and skill development in how to proceed with their care. The paper helps with this as it is able to offer suggestions, based on the findings. These include:
Offering a whole range of medications that are likely to be effective and helping the young people to choose what is appropriate for them, bearing in mind that ease of timing, discreet application and benefits to weight are priorities they have expressed.
Sharing information about the implications of having diabetes, not only verbally, but offering further information about sources of information and support, which are available in ways that they might be willing to access - online, Apps, peer support forums.
Involving the family in supporting the young person and emphasising how this can help. This includes giving practical guidance about food 'swaps' at little cost and simple activity increase, such as walking.
Exploring the young person's own perception of what having diabetes means and how to share the information (or not) with their friends and peers. This could also include directing them to online support for young people experiencing peer issues, such as bullying, in any context.
This is a very practical list and we would venture to add the consideration of introducing young people with Type 2 diabetes to each other and supporting their discussions, informally or in a group discussion format (2 or 3 counts as a group), as well as helping them to learn ways of effective self management and strategies for confidence building and relaxation.
Like some of the other suggestions above, there may well need to be the involvement of some specialist workers, who support young people. This could be another valuable investment, as they can, in turn, perhaps help to 'up skill' diabetes practitioners to support the young people with Type 2 diabetes they will inevitably meet in future.
This paper gives a wonderful opportunity and practical insights into this vital and growing group of people and their needs. As ever, we will be doing our bit to broadcast its findings and contribute ideas for practical implementation. It's a timely chance for us all to 'start as we mean to go on' and really make a difference to their future.
Hot on the heels of this blog post, we became aware of another paper about young people with Type 2 diabetes, this time from Australia and reporting work with young adults between 18 and 39. The authors compared a group of people of this age with the same number of older people also with Type 2 diabetes, and with the same number and age range of people with Type 1 diabetes. They investigated anxiety and depression levels, medication taking behaviour and healthy eating and physical activity levels.
They found that the young people with Type 2 had more depression and were less likely to eat healthily than older people with Type 2, less likely than the same age group with Type 1 diabetes to be physically active, and less likely than either of the other groups to take insulin as recommended. The authors conclude that these young adults with Type 2 have particular needs in relation to psychology and self-care support.
This evidence seems to add to our conclusion above about the importance of the 'support spotlight' falling on these young people and their challenges, who need to be seen as distinct from either others with Type 2 or their Type 1 counterparts. As the NICE (National Institute for Health and Clinical Excellence) UK guidelines for managing Type 1, Type 2 and Children and Young People with Diabetes are all currently being updated, this paper also offers brilliantly timed messages.
Turner, KA., Percival, J., Dunger, DB., Olbers, T., Barrett, T., Shield, JPH. (2015). Adolescents' views and experiences of treatments for Type 2 diabetes: a qualitative study. Diabetic Medicine, 32, 250-256
Browne, JL., Nefs, G., Pouwer, F., Speight, J (2015). Depression, anxiety and self-care behaviours of young adults with Type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) study. Diabetic Medicine, 32, 133-140