Type 1 diabetes is often diagnosed in childhood. In most cases, parents are directly responsible for their child’s medical care until the latter becomes progressively more independent in their teen years. But how can we ensure a smooth transition from paediatric care to adult care so that young people can become self-sufficient in their treatment? Dr. Jennifer Ducharme, Clinical Psychologist, answered this question at the last Diabetes Canada conference, held in Winnipeg in October 2019.
Different aspects of development
To understand why teenagers actively participate in their treatment or why they don’t, we have to take psychosocial factors into account in addition to the young person’s medical knowledge. For example, we should consider the context in which the child is growing up. Everyone has their own potential and reaches it at their own distinct pace. A child can be at a different stage in different areas, which include the physical, cognitive, social and emotional spheres of development.
- Physical development includes hormonal and physical changes. The growth hormone tends to increase insulin resistance during adolescence, which means insulin doses often need to be increased during puberty. Teenagers can also be more concerned by the physical changes they’re going through and start questioning their identity more. You often see young people wanting to belong to a social group and not stand out from others. Sometimes, paying too much attention to physical appearance can lead to eating disorders, which may in turn impact diabetes management.
- As a concept, cognitive development is more abstract and can explain why a young person’s has difficulty to assess a situation. This development is why teenagers can adopt riskier behaviours or sometimes fail to consider long-term consequences.
- Finally, in the course of their social and emotional development, teenagers often have a greater desire for independence generally and from their parents especially. They may focus more on their need for affirmation or their romantic relationships than on their diabetes treatment.
How can we support teenagers?
We need to take all these developmental changes into account when trying to support teenagers in building their autonomy and transitioning to adult care.
Teenage years involve the responsibility for care being transferred from parents to their child, but also multidimensional changes occurring in the child. The time this transitional period can take is different for everyone, which is why it’s important to evaluate whether the teenager feels ready to take direct charge of their medical care.
Health professionals, parents (or guardians) and the teenager themselves should start by sharing the medical responsibilities so as to reduce feelings of distress and anxiety. At the beginning of the transition, parents can mentor their child and help determine which aspects of treatment can be transferred to the teenager. The family needs to communicate properly and be ready to invest the necessary time to resolve potential conflicts.
In addition to family factors, the teenager’s peer influences and their entire psychosocial context will have to be taken into account to ensure they are more involved in their treatment and enjoy a better quality of life.
Ducharme, J. (2019). Psychosocial and Developmental Influences on Diabetes Management, Treatment Adherence, and Outcomes in Adolescence. Lecture presented at the Diabetes Canada/CSEM Professional Conference, Winnipeg, Canada.