The adolescent and young adult years are difficult enough for a young person to handle, the additional burden of managing diabetes making this even harder. Although there are a handful of patients with Type 2 diabetes at this age – usually from certain ethnic groups or with a variety of genetic syndromes, the vast majority of patients have Type 1 diabetes. Whilst this is often diagnosed in relatively early childhood, the peak age of diagnosis is at 10-14 years. As such, the majority of these patients take insulin with all the issues that this involves.
During adolescence, patients pass from being dependant on carers (usually parents) to help them manage their diabetes, both from insulin administration and diet, to being autonomous with increasingly variable activities and social interactions. All the physical and behavioural changes in teenagers impact on their diabetes control – the endocrine aspects of growth, teenage rebellion, driving, alcohol, recreational drug taking to name but a few.
For many patients at this age, there is often a certain degree of rebellion manifesting itself as disregarding attention to diet, monitoring and even insulin administration – the latter frequently an issue in girls concerned about weight. However, for the more motivated patient, it is also an opportunity to give the patient more control of their diabetes including diet and insulin. Many patients are already using a basal bolus regimen before they enter their teenage years but for those who are not, it is probably the most flexible available apart from an insulin pump which are increasingly used. Furthermore, this group of patients are usually happy to increase the level of technology they use – gone are the blood stained glucose diary, replaced by smart phone compatible meters and accompanying apps.
Usually the transition from paediatric to adult care happens in adolescent or transitional clinics shared by the paediatric and adult diabetes team (which may involve psychology input). This gives the patient the opportunity to meet the adult team but also signals a change in the manner of which the consultation takes place – away from a more prescriptive meeting to a partnership. In these clinics, the patients can be reviewed in an adult diabetes centre rather than the paediatric clinic but also not in a general adult clinic where the patients are usually much older. More time can be spent with the patient than in a routine adult clinic. Other issues that arise include leaving home, university life or entering employment. Ultimately, the aim of adolescent services is to ensure that at the end of this period of a patient’s life they remain fully engaged with health care professionals and can self manage their diabetes.
Dr Mark Freeman