April 11, 2008

Study tracks barriers to managing diabetes

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Russell Rothman, M.D., and Shelagh Mulvaney, Ph.D., are studying how children with diabetes perceive their condition. (photo by Dana Johnson)

Study tracks barriers to managing diabetes

A new study shows that children with obesity-related diabetes are reporting serious difficulties in making basic lifestyle changes that could save them from a lifetime of complications.

The study of 103 adolescents (ages 12 to 21) with type 2 diabetes, most of whom are overweight, shows many children and teens do not possess good self-management behaviors. The study — published in the April issue of the journal Pediatrics — was conducted by the Vanderbilt Diabetes Research and Training Center, working with patients at the Vanderbilt Eskind Pediatric Diabetes Clinic.

The respondents reported that making basic lifestyle changes that will lead to better future health, in areas such as diet and exercise, is more difficult than adjusting to medical management of their disease. Medical management includes daily medicines, blood sugar monitoring and injections of insulin.

“Type 2 diabetes in children is such a new problem that we don't know a lot about these kids,” said Russell Rothman, M.D., deputy director of the Prevention and Control Division of the Vanderbilt Diabetes Research and Training Center. “This study is one of the most comprehensive to date to look at who these kids are and the challenges they and their families face trying to take care of themselves.”

Rothman and Shelagh Mulvaney, Ph.D., assistant professor in the School of Nursing, along with physicians and nurses from the Eskind Pediatric Diabetes Clinic, performed the telephone survey. Most children were either overweight or obese (possessing a body mass index (BMI) over 85 percent of the average for their age and weight).

More children (37 percent) reported the most difficult part of managing their disease was changing health habits like diet and exercise; 31 percent perceived taking insulin to be the most difficult part; and 18 percent had the toughest time adjusting to finger sticks for blood sugar tests.

More than 80 percent of patients reported taking medication regularly, and nearly 60 percent monitored their glucose twice daily. However, about 70 percent reported watching at least two hours of TV each day, and 63 percent said they did not currently participate in physical education classes. Children reported that barriers to making changes were: dealing with cravings or temptations, feeling stressed or sad, and frequently eating outside the home.

The study also found racial disparities, with African-American patients having worse blood sugar control. African-American patients also were slightly more likely to behave like adolescent peers without diabetes — drinking sugary drinks and regularly eating junk foods. While not the target of the survey, these findings open up the possibility of future surveys to better understand the reasons for the disparities.

“These results indicate children are having a very difficult time, and so you might think it would be very difficult to take care of themselves long-term,” Rothman said. “This will mean a major health crisis for the country to deal with later. We owe it to ourselves, as well as to these young patients, to find better ways to help them manage their obesity and diabetes.”