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Young adults with diabetes require new approaches to education

0809-Young Adults

Christina Roth: ‘71 percent of college students report having difficulty managing their diabetes while at school.’

Young adults ages 18 to 26 with type 1 diabetes have an average A1C that is significantly higher than what American Diabetes Association guidelines call for, and the A1C percentage is trending higher in this age group.

A breakout session Thursday brought together four speakers to discuss “Supporting Young Adults with Diabetes: Changing Systems to Address the Issues” and explain how each of their organizations reaches out to these young people with diabetes.

According to data from the T1D Exchange Clinic Registry, average A1C percentages go up in the teenage years and don’t stabilize until the individuals reach age 30, said Christina Roth, chief executive officer and founder of the College Diabetes Network in Boston.

“At any given time, there are an estimated 53,000 college students with type 1 diabetes in the United States,” Roth said. “Seventy-one percent of college students report having difficulty managing their diabetes while at school.”

The College Diabetes Network has 59 chapters across the United States that create student communities on campus centered on supporting young adults with type 1 diabetes. Each chapter allows students to connect with each other and learn about the latest diabetes technology and gadgets, and exchange tips and tricks for managing diabetes on campus.

“Peer support is the most effective way of reaching out to college students with diabetes,” Roth said.

Gary Scheiner, MS, CDE, owner and clinical director of Integrated Diabetes Services in Wynnewood, Pennsylvania, said his multidisciplinary team of CDEs with diabetes offers young adults with diabetes unique service options, such as video chat appointments, Web-based data downloads and smartphone apps.

The services center on the client’s needs and interests, providing individualized, nonjudgmental care; updates on new pumps, sensors and meters; weight control advice; and ways to avoid hypoglycemia.

The CDEs involve parents and urge them to monitor how well their young-adult children are self-managing their diabetes, set realistic ground rules of behavior and enforce the rules, Scheiner said.

Pediatric psychologist Jodie M. Ambrosino, PhD, associate research scientist at Yale University School of Medicine in New Haven, Connecticut, described the Yale children’s diabetes program and its forge ahead and bridge transition program to help adolescents with diabetes transition into young-adult care in college.

Ambrosino and her colleagues assess the adolescents’ readiness to transition and knowledge of type 1 diabetes through psychosocial screening surveys, including a type 1 diabetes knowledge quiz, the Patient Health Questionnaire, Diabetes Distress Survey, Hypoglycemia Fear Survey, and Self-Care Inventory.

They offer entering freshmen an Off-to-College Day to cover the nuts and bolts of self-care in college, adjust insulin levels, discuss what A1C levels mean, talk about blood glucose and A1C goals, explain the possible long-term complications of type 1 diabetes, and describe how exercise affects blood glucose levels. They also offer a college student dinner every December to talk about reducing stress and managing nutrition, Ambrosino said.

“The transition needs to be purposeful, planned and gradual,” she said. “A team approach is essential to address the multiple domains of care, and time is needed to approach the barriers to care and optimize the outcomes.”

Finally, Cari Berget, RN, BSN, CDE, a pediatric nurse diabetes educator at the University of Colorado’s Barbara Davis Center for Childhood Diabetes in Denver, discussed a team-based approach to diabetes care used at the Davis Center.

“We’ve come up with a team clinic. It’s an innovative approach to routine medical care and a different way of structuring a quarterly diabetes clinic visit to make better use of the time we have with our patients,” Berget said.

The clinic involves a multidisciplinary team comprising nurse practitioners, diabetes educators, registered nurses, registered dietitians, and social workers working within a positive psychology framework.

“Positive psychology maintains that positivity has a better impact than negativity by focusing on what’s going well rather than what’s not going well,” she said.

In the clinic, patients with diabetes spend one-on-one time with a healthcare provider and then go to a group session to set goals for the visit. Then they discus plans to meet the goals with a diabetes educator or other team member. Parents meet in a group separately to learn about how diabetes affects their children.

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