June 30, 2006

Teens’ self management of diabetes studied

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Russell Rothman, M.D., and Shelagh Mulvaney, Ph.D., have found that children with type 2 diabetes may require different treatment approaches than previously thought.
Photo by Dana Johnson

Teens’ self management of diabetes studied

In one of the first studies to look at barriers to self-care in adolescents with type 2 diabetes, researchers at Vanderbilt University Medical Center found that children with type 2 diabetes may require different approaches to treatment than those with type 1 diabetes.

Lead author Shelagh Mulvaney, Ph.D., reported last month in Diabetes Care that parents play a crucial role in promoting positive self-management habits among their teenagers with type 2 diabetes.

“The behavioral aspects of type 2 diabetes can be somewhat unique compared to type 1 diabetes. In type 2 diabetes, multiple family members often share the diagnosis or are dealing with obesity. When multiple family members share a disease there may be either positive or negative role modeling going on regarding self-management behaviors such as diet, exercise and medication adherence,” Mulvaney said.

Russell Rothman, M.D., assistant professor of Medicine and Pediatrics, said they gathered evidence for the study in interviews and focus groups with families from the Pediatric Diabetes Center (now part of the Vanderbilt-Eskind Diabetes Center).

“We also found that children with type 2 diabetes are often diagnosed during adolescence — at the same time that they are transitioning into adulthood, testing boundaries and taking more risks. So they are diagnosed at a time when they may be less responsive to dealing with health problems, particularly those that they may not see as an immediate threat to their health.”

Within the focus groups, parents shared many of their own parenting techniques, such as treating the teen with diabetes as any other child and providing incentives for them to perform glucose monitoring, exercise and other self care.

Encouraging a healthy lifestyle among all of the family members was thought to help avoid conflict and promote proper self-management behavior among the adolescents with type 2 diabetes.

Mulvaney said these results could help clinicians and researchers, because they reflect the everyday experiences and conflicts of families with diabetes. Mulvaney and her colleagues identified several barriers to self-management among adolescents with type 2 diabetes including: perceived lack of normalcy in peer relations; barriers in the school and community environment; and aspects of typical adolescent development, such as the desire for independence.

They found, for example, that some teenagers tried to hide their condition in order to be accepted by peers, thereby neglecting their health. The parents also reported that unhealthy food choices are often abundant at school.

“From this study, families provided us with recommendations for ways to try to optimize care for adolescents with diabetes,” Rothman said.

Strategies that might help to improve care for adolescents with diabetes include: increasing peer-to-peer relationships and support groups; developing more family-oriented interventions to help address diet, exercise and diabetes management; recognizing and addressing peer pressures faced by adolescents with diabetes; and improving diabetes education to the adolescents, their families and the schools.

The study was funded by a K23 Career Development Award grant from the National Institute of Diabetes, Digestive and Kidney Diseases. Co-authors included David Schlundt, Ph.D., Eniola Mudasiru M.D., Mary Fleming M.D., Ann Vander Woude, M.S.N., William Russell, M.D., and Tom Elasy, M.D. M.P.H.