Type 2 Diabetes in Children + Teens: A History of Care + its Challenges
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Presentation: Individualizing Diabetes Care and Education for Children, Teens, and Young Adults with Diabetes
Speakers at this ADA Scientific Sessions presentation included: Paul McGuigan, RN, CDCES from Case Western Reserve University, Anastasia Albanese-O’Neill, PhD, APRN, CDCES, University of Flordia, Julia Blanchette, PhD, RN, BC-ADM, CDCES, University Hospitals Cleveland Medical Center, Christina Roth, College Diabetes Network, Karen Kemmis, PT, RN, MS, DPT, SUNY Upstate Medical University
This article focuses on the presentations of Paul Mcguigan, who works on pediatric type 2 diabetes education.
History of type 2 diabetes in children + teens
The diagnosis rates of type 2 diabetes are on the rise in children and teens in the United States—though it’s possible many young people with type 2 diabetes (T2D) may have been misdiagnosed in the past.
About 3,600 to 5,000 children are diagnosed with T2D each year, explained Paul Mcguigan, RN, CDCES.
Only in the 1990s did doctors and researchers recognize that not all children diagnosed with diabetes had type 1 diabetes.
Until the early 90s, nearly all young people diagnosed with diabetes were educated and treated as if they had T1D. As a result, they were often started on insulin therapy—this was also at a time when metformin was not approved for children and adolescents.
Diagnosing T2D in young people is complicated
Over a quarter of young people in the United States are obese.
A common symptom of diabetes is rapid weight loss—when the body is burning fat in a dangerous and unhealthy manner because there isn’t enough insulin present to use glucose for fuel.
In children who are overweight or obese, this warning sign of diabetes can be easily missed.
According to Mcguigan, about 5 to 25 percent of young people are in diabetic ketoacidosis (DKA) at the time of diagnosis. DKA is the result of dangerously low insulin levels—it is life-threatening and can be fatal if it is ignored for too long.
Another 40 percent of young people with T2D are asymptomatic—potentially due to blood sugar levels not being quite high enough to trigger noticeable symptoms. Because so many children and teens are asymptomatic at the time of diagnosis, they may underestimate the seriousness of the disease.
Lab testing is necessary to confirm a diabetes diagnosis and the results can take weeks to return. Follow-up visits can be a burden on the family or caregiver due to travel constraints, missing school and work and the general costs associated with every aspect of receiving healthcare.
Challenges to diabetes education in youth
Working with children and teens with diabetes also involves working with their families.
Providers have an obligation to educate a young patient’s parents or guardians about diabetes. However, young people experiencing less stable housing may not have their legal guardians with them when meeting with a provider. This creates additional challenges for the provider because it means the patient’s caretakers may not necessarily receive proper education on managing their child’s diabetes.
Other factors that can pose barriers to diabetes education for young people with T2D and their families may include:
- Mental illness or substance use within the home
- Homelessness or housing instability
- Domestic violence or sexual abuse
- Dropping out of school
- Family members experiencing unemployment or incarceration
- Military deployment
- Food insecurity
- Living in a food or pharmacy “desert”
According to the TODAY study, over 60 percent of participating young people with T2D developed a diabetes-related complication by their late 20s, and over a quarter developed at least two complications.
Involving the family
Type 2 diabetes can be a more volatile disease when diagnosed at a young age.
Young people with T2D may have or live with other family members with the condition. Due to a lack of diabetes education or common misconceptions, family members may believe T2D “is not that bad.” This risks undermining the patient’s diabetes management and understanding of their diabetes.
Some family members may also question the diagnosis. In families that have members with diabetes, some might also assume they understand diabetes and diabetes management, missing opportunities to correct misconceptions or learn new information.
There’s also the “inevitability factor.” Some people with a family history of diabetes may believe their own diagnosis and future complications are inevitable because they’ve watched it unfold that way in other family members.
Because young people with T2D usually don’t get regular, ongoing care from a provider, their T2D is more likely to progress and cause complications at an earlier age. According to McGuigan, after the diabetes diagnosis, it’s not uncommon for a provider not to see a young patient again until they are experiencing complications.
These factors all complicate providing comprehensive diabetes care to young people with T2D. Providers have to engage the family system around the patient and adapt and respond to a child or teen’s circumstances. Through individualized and comprehensive diabetes care and education, young patients will be better equipped to accept and understand their diabetes, setting a strong foundation for diabetes management into adulthood.