Home / Resources / Articles / ADA Stresses Differences in Care Between Pediatrics and Adults with Type 1 Diabetes

ADA Stresses Differences in Care Between Pediatrics and Adults with Type 1 Diabetes

Sep 1, 2018
 

Care plans recommended for children with type 1 diabetes and their caretakers in order to best suit their changing needs.

Managing type 1 diabetes in pediatric patients should not be extrapolated from adult diabetes care. When creating care plans, providers should keep the child’s development stages in mind to best suit his or her changing needs, according to a recent update of the ADA’s original position statement from 2005. Desmond Schatz, MD, and colleagues focused on the importance of the child  for the child and his or her caregiver adapting to type 1 diabetes management based on transitions from toddlerhood to adolescence. The statement emphasizes the importance of type 1 staging, proper screening, hypo- and hyperglycemia management, and special considerations.

“Children are not young adults,” Dr. Schatz said in an interview. “They have unique challenges and developmental phases, challenges of growth, challenges of puberty and challenges related to the [young adult] transition, as well as challenges related to independence and paying for care.

“The medical community needs to be aware of these challenges, particularly at a time when it’s not easy. We as a health care team need to support children and their families through all phases of vulnerability.”

Common developmental and diabetes demands, along with priorities across childhood

 

Ages & Development Levels Usual Developmental Task T1D Priorities for Management Considerations due to T1D
1-2 years; infancy-toddlerhood Bond with caregivers;

first words & walking

Reduction of large fluctuations in glucose levels; prevention of hypoglycemia (caregiver) Identifying symptoms of hypo- and hyperglycemia; coping with stress related to management of diabetes
2-6; late toddlerhood-early childhood Begin school; exploring new challenges and activities Reduction of large fluctuations in glucose levels; prevention of hypoglycemia; trusting others to help with care (child & caregiver) Planning for means of monitoring when not with child; monitoring diet and adjusting for variable appetites; stress of management
7-11 years; late childhood Developing physical, social and academic skills; still reliant on caregiver Helps identify symptoms and treatment of hypo- and hyperglycemia; Developing ways to correct regimen if plans or activities change (child with guidance from caregiver) Teaching child symptoms of hypo- and hyperglycemia and management of diabetes; coping with stress of complex schedules and eating patterns
12-15 years; early adolescence Managing body changes and “fitting in”; desires less from caregivers, yet still needs it Decisions for diabetes care and regimens; expectations to monitor glucose when away from caregiver (teen) Coping with increase conflict about diabetes management; supervising enough, but encouraging independence
16-19 years; late adolescence Increased thinking & worries about what’s next; expected to make decisions based on interests and opportunities Decreased guidance and supervision; Discussions on different healthcare providers (teens, caregivers, and care team) Independence; modeling positive decision making; preparing for complete independence for next phase in life

Most children with type 1 diabetes require intense insulin regimens with multiple daily injections and continuous glucose monitoring. According to researchers, automated insulin pumps are encouraged in children and adolescents with type 1 for reductions in hypoglycemia and optimal glycemic control. Educating the child on lifestyle management is also highly encouraged, with comprehensive nutrition education and daily exercise. Trained mental health professionals should assess everyday family stresses during routine follow-up care.

Adolescence is a crucial time where diabetes management may be disrupted by decision making and risk-taking behaviors. Psychosocial evaluations are highly encouraged by health care professionals to assess the adolescents’ medical regimens and self-management of type 1.

Managing type 1 diabetes can be challenging for children and their caretakers. Reaching out to health care professionals and beginning to empower children at a young age is imperative for future independence and management of the disease.

Practice Pearls:

  • ADA recommends creating care plans for children with type 1 diabetes and their caretakers in order to best suit his or her changing needs, with emphasis on the importance of type 1 staging, proper screening, hypo- and hyperglycemia management, and special considerations.
  • Most children with type 1 require extensive therapy with multiple daily injections, along with proper diet and exercise training.
  • Adolescence is a vulnerable time in a child’s life that includes risk-taking behaviors and decision making. Empowering children to make good choices by educating them about the disease is crucial.

Reference: Schatz, D., et al. “Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association.” Diabetes Care. Jul 2018, dci180023; doi: 10.2337/dci18-0023

Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy