Managing Diabetes in Young Adults: New Guidelines

Anne L. Peters, MD, CDE


October 26, 2011

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Hi. I am Dr. Anne Peters, Director of the Clinical Diabetes Programs at the University of Southern California. I am here today to tell you about the first-ever guidelines for the care of emerging adults with diabetes. These guidelines are published in Diabetes Care,[1] and I was the cochair of the committee that developed these guidelines so I happen to know a fair amount about them. I want to explain first what this means, and second what you can do to make a difference with these patients in your practice.

It turns out that there is a developmental phase known as "emerging adulthood." This phase is between the ages of 18 and 30 years. If you think about it, that is the point in time when people go through the most change. They leave their families, they go off to school, they find their own apartments, they get jobs, and it's the period in life when people move the most. They have relationships. They may fall in love and get married. They may start a family or they may not, but it's a time when there is a great deal of change.

At the same time, for people with diabetes, a very fundamental change takes place. Emerging adulthood is when they go from pediatric care to adult care. In most settings, those models of care are exceedingly different. In pediatric care, for patients under the age of 18, the healthcare system and the parents are responsible for the child. That means there is a lot of family involvement and a lot of nurturing. Someone is doing a lot of things for that young person with diabetes. Once they hit adult care, they enter the world of individualized care. In that world, your parents don't necessarily know anything about your healthcare. It is the world in which you are meant to make your own healthcare decisions. There is a lot less of that nurturing type of group care that occurred in pediatric care. It isn't always the case, but in many instances, a person's care is much more independent. We ask a lot of these young people with diabetes to change from the pediatric care model to the adult care model.

What can we do to make this easier? One thing is that pediatricians should help their teenage patients to prepare for this transition. A lot of education needs to go on and a gradual shift of responsibility from parent to teenager in terms of their care. Once the young person comes into the realm of adult care, it is very important for us to recognize the vulnerability of these young people. They may not be so good at remembering to refill their prescriptions. They may not know how to get reimbursed by their insurance. They may need re-education. They need a lot of things that perhaps our older patients don't need in terms of nurturing and getting connected with the healthcare system.

Another fundamental difference in adult care is that we tend to focus more on screening for and treating complications. This tends to be much rarer in pediatric care, and although rates of complications are lower in young adults with diabetes, it is not unheard of to find a patient with early nephropathy, retinopathy, or neuropathy, so it's important to start doing some of that screening and talking about it with the patients, to help them understand what we are looking for, why we are looking for it, and what we can do to help. Other things that are important to look for include eating disorders (which may be more common in individuals with diabetes) and depression. In young women, we want to talk with them about issues of both contraception and planning pregnancies and how to deal with that when and if they are ready to have children.

This is a very interesting time; a time when we need to treat patients just a little differently both before and after this transition to adult care. It is a time when we can really help bond with our patients. I love seeing my patients through these years and watching them go from "lost college students" to getting jobs to having families. It is gratifying, and I believe we can do a lot to help during this period of transition. We also need to do a lot more research. Many questions remain unanswered, but this new position statement and set of guidelines are a good first step in helping us be aware of this vulnerable time in our patients' lives. This has been Dr. Anne Peters for Medscape.


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