Parkland helps youth with diabetes transition to adult care
Rate of diabetes rising, transition poses special challenges
It’s the start of the school year — time to say so long to summer and howdy to homework. For children with diabetes, school presents special challenges, from monitoring meals and medications to measuring blood sugar. And for teens with diabetes leaving home for college or independent living, it’s time to “graduate” from pediatric to adult healthcare. That transition can be difficult and put them at risk of poor diabetes management, according to staff at the Global Diabetes Center at Parkland Health & Hospital System.
“Diabetes is a complex, chronic disease that requires the expertise of specialists including endocrinologists, dietitians, pharmacists, diabetes educators and behavioral health counselors,” according to Kellie Rodriguez, MSN, MBA, CDE, Director, Diabetes Education & Community Engagement at Parkland. “Studies show the transition to adult care is a vulnerable time when patients have to find new healthcare providers, deal with issues like drugs, alcohol and sexuaity, adjust to college and work, and the potential of increased depression or anxiety.”
Dechairra Reed, 21, of Dallas, was diagnosed with type 1 diabetes at age 5. Her transition to adulthood hit a road bump when she was 17, failed to see a doctor for several months and had to be admitted to Parkland when her blood sugar soared.
“When I was young, my mom managed my care but as a teen I had to learn to give myself insulin shots and watch my blood sugar. I wasn’t handling it well for a while,” she said.
Now a regular patient at Parkland’s Global Diabetes Center, she received “lots of help with education and getting the medication I need. Diabetes can be frustrating because it’s unpredictable. It’s not easy, but as I get older I understand better how to take care of myself.”
Jasmine Jackson, 20, of Garland, was diagnosed with type 1 diabetes two years ago as a high school senior. Finding a medical team was challenging. “If I’d gotten better instruction in the beginning, I wouldn’t have had so many problems managing my diabetes,” she said.
After she was referred to Parkland’s Global Diabetes Center, Jackson said she got the support and education she needed. “It took me about a year to learn how to deal with this disease. I have to give myself shots four times a day and be very careful about what I eat.”
In high school, Jackson kept her condition private. “I didn’t want to be known as that ‘sick girl,’” she said. But in college, she joined a support group of other students with diabetes. “Diabetes has helped me connect with people differently. I still live at home because my family gives me a lot of support. I’m really lucky to have the doctors and nurses at school and Parkland helping me.”
Rates of new diagnosed cases of type 1 and type 2 diabetes are increasing among youth, according to a recent report in the New England Journal of Medicine. In the U.S., 208,000 people younger than 20 years are living with diagnosed diabetes. From 2002 to 2012 the rate of new diagnosed cases of type 1 diabetes in youth increased by about 1.8 percent each year. The rate of new diagnosed cases of type 2 diabetes increased even faster, at 4.8 percent.
Type 1 diabetes is the most common form of the disease in young people. Patients with this condition must take insulin to stay alive and healthy. In type 2 diabetes, the body does not make or use insulin well. In the past, type 2 diabetes was extremely rare in youth but has become more common due to lifestyle factors such as obesity, poor nutrition and lack of exercise.
Parkland provides care for more than 50,000 adults with diabetes. Pediatricians generally are no longer able to treat children after age 18, so Rodriguez recommends that parents prepare their kids over a period of years to begin taking over their care management.
To assist young adults ages 16 to 24 transitioning to adult diabetes care, the Global Diabetes Center offers patients and parents shared medical appointments (SMAs) for peer support and education. Diabetes educators, social workers and clinical staff create individualized plans of care to assist with medical needs, insurance coverage, appointment scheduling, emotional and social support, and coordination between pediatric and adult medical care teams during their transition.
Experts advise parents to teach their child at an early age to speak to their doctor and ask questions at each visit. Older children can go with you to the pharmacy, learn how to refill prescriptions, fill out medical forms and schedule appointments.
“From the moment a child is diagnosed with diabetes, they should be engaged in their care. Even a 3-year-old can learn to make decisions, like which finger they want to prick for their blood glucose test,” Rodriguez said. “As kids mature, they should gradually be given more responsibility. It will make that last big step from pediatric to adult care much smoother.”
Rodriguez recommends that college-bound youth with diabetes visit the website www.collegediabetesnetwork.org for resources to help manage diabetes at college and at work, including a list of campus chapters that provide peer support. To learn more about diabetes, visit www.diabetes.org. To learn more about services at Parkland hospital, visit www.parklandhospital.com.
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