Minority adolescents with type 2 diabetes face behavioral, social challenges

The families of ethnic minority adolescents with type 2 diabetes described difficulties in managing their children’s knowledge deficits, maintaining adherence to healthy regimens and handling the disclosure of diabetes in social relationships, according to data published in The Diabetes Educator.

“The management of pediatric [type 2 diabetes] is challenging and requires daily self-regulation on behalf of both parents and youth,” Sara M. St. George, PhD, of the department of public health services at the University of Miami Miller School of Medicine, and colleagues wrote.

Researchers added that previous studies had shown higher rates of adherence failure in black and Hispanic youths than in white youths.

“The field would benefit from triangulating data from multiple sources simultaneously (eg, adolescents and parents) to develop a more comprehensive picture of the family experience of pediatric [type 2 diabetes]. Specifically, because parents and adolescents must work together to effectively manage pediatric [type 2 diabetes], interviewing them together may provide important insights regarding key challenges that would otherwise go unobserved if each were interviewed in isolation.”

The researchers performed a descriptive qualitative study of black and Hispanic adolescents with type 2 diabetes and their parents (79.2% black, 29.6% Hispanic; n = 14, mean age 14.7 years for adolescents; n = 13, all women for parents). St. George and colleagues identified six themes across three broad categories: cognitive, behavioral and psychosocial challenges. Cognitive challenges included problems learning about a new disease and handling deficits or superficial knowledge among patients; behavioral problems included regimen adherence and positive behavioral challenges; and psychosocial problems consisted of adolescents’ emotions related to diabetes and difficulties explaining diabetes to peers and relatives.

St. George and colleagues included a table of quotes from interviewees exemplifying each type of problem.

“For me, you know, I am lost with that because that is why I asked the question, ‘What’s the difference?’” one parent told an interviewer, regarding the difference between type 1 and type 2 diabetes. “And today I just realized what the difference is.”

In terms of managing superficial knowledge, one parent said, “He asks me, ‘Mom, do you think that one day I’ll get rid of it?’ And I have no idea so I tell him, ‘I don’t know. I’m not sure how to respond to that.’”

Adolescents also described difficulties explaining diabetes to their friends and peers.

“My friends know,” one patient said. “And some of my acquaintances … sometimes I’ll tell people and they’re like, ‘Oh, I’m sorry to hear that,’ and I tell them, ‘Don’t be, it’s not like I’m dead, I just have diabetes.’”

“Treatment of pediatric type 2 diabetes is complex and requires engagement from the family system,” the researchers wrote. “Increasing family knowledge of type 2 diabetes, enhancing positive parenting skills specific to pediatric type 2 diabetes care, and screening adolescents for psychosocial issues as a part of standard care are all concrete steps that may be taken to improve youth outcomes.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.