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Peers can be part of the diabetes treatment team for teens
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Adolescence is a time when adherence to the diabetes treatment regimen is poor and HbA1c values are higher than at any other time of life. There are many reasons for this, including the normal psychological need for teens to become more independent, to question and often defy authority, and to be accepted by their peers. They feel invulnerable and may participate in risk-taking behaviors, including not doing the diabetes-related tasks necessary to succeed with their disease management.
Teens with diabetes do not want to be perceived as different and, because of that, they often listen to their peers more than they listen to authority figures, including parents and their diabetes team.
Bring-a-friend camp
Because peers have such an important influence on adolescent behavior, the Florida Camp for Children and Youth with Diabetes created a bring-a-friend weekend, in which teens (primarily middle schoolers) with type 1 diabetes invite a friend without diabetes to spend a weekend with them. More than 100 teens have attended the camp in each of the past several years, with 130 attending in 2015.
Janet H. Silverstein
Approximately five camper–friend dyads stay in cabins in age-matched groups. All diabetes-related tasks except for mealtime insulin doses are performed in the cabin. Meals are served family style with a sample plate of all foods being served, including serving sizes and their carbohydrate content, placed on a table at the entrance to the dining hall. In addition, all counselors get a sample menu indicating the carbohydrate content of all foods served, and they double check the campers’ meal bolus calculations and observe all insulin injections/boluses.
A variety of activities are performed throughout the day and evening, with a group discussion session for youths with diabetes and former campers who are now in college or recently graduated. A medical professional is present to make certain all information is correct.
The friends have a concurrent session in which they are taught about the basics of diabetes, how to recognize and treat hypoglycemia, the importance of checking blood glucose levels and insulin administration for meals and snacks, and how to help their friend deal with their diabetes. Although only an hour is devoted to these sessions, the campers’ discussions usually last 2 hours or more.
Feeling ‘different,’ helpful
To assess how the adolescents with diabetes and their friends felt about the role of peers in diabetes management, our psychologist administered the adolescent and peer versions of the Talking About Diabetes Survey to the 70 youths aged 11 to 16 years attending the teen weekend in 2008. About one-third reported that having diabetes made them feel different from their peers and interfered with social activities. Their friends were most concerned about the complications — both acute and chronic — of diabetes. About half of the friends believed diabetes did not interfere with social activities, but one-third said diabetes-related tasks take time away from activities. Many of the participants with diabetes said they had difficulty explaining the disease to their friends, and their friends concurred, stating they wished they had learned more about the tasks involved in diabetes management.
When asked what they liked most about the weekend, the youths with diabetes were glad their friends were able to see what was involved in managing their disease. Their friends appreciated learning about diabetes and reported feeling more knowledgeable about helping their friends succeed with their diabetes care.
When asked how friends could help them, the youths with diabetes stated their friends could remind them to perform their diabetes-related tasks. It also was thought that their peers could help them monitor for symptoms of hypoglycemia. However, about two-thirds didn’t think their friends needed to do anything besides what they were already doing. Another one-third felt that their friends could help by not making a big deal about their diabetes. Half of the peers said they could help their friends by providing reminders, and about one-quarter thought they could help by assisting with diabetes-related tasks. About 12% said they could help by providing emotional support.
Several youths with diabetes stated that they had difficulty explaining diabetes to their friends, and both groups reported that they would benefit from knowing more about what medical tasks are needed to adequately care for diabetes.
Lessons for clinicians
These comments provide insights into what we, as clinicians, might do to improve adherence in those adolescents who are not giving insulin boluses before meals, not checking their blood glucose levels frequently enough, or otherwise not doing what they need to do to optimize their diabetes control. Both the youths with diabetes and their friends believed that the peers could help their friends with managing their diabetes. Potential ways of achieving this are to invite friends to a camping program, invite friends to a clinic visit, or offer to help set up support groups in which both those with diabetes and their friends are invited.
The diabetes team could incorporate teaching their preadolescent and adolescent patients ways to approach the issue of discussing their diabetes regimens and what the friends could do to help them with their diabetes management. By empowering their friends to help them, adolescents with diabetes could potentially cope better with their diabetes care and improve adherence to their diabetes tasks.
References:
- Lehmkuhl H, et al. J Clin Psychol Med Settings. 2009;doi:10.1007/s10880-009-9164-9.
For more information:
- Janet H. Silverstein, MD, is an Endocrine Today Editorial Board member; email: silvejh@peds.ufl.edu. She reports no relevant financial disclosures.