Social media, Skype, and other similar tools should be used to keep young people engaged in their diabetes management as they move from child and adolescent care to adult services, recommends new UK guidance.
The guidance, developed by National Health Service (NHS) England, highlights the difficulties faced by young people with diabetes, such as an increased risk of eating disorders and psychosocial issues, which can affect their participation in healthcare at a crucial point in their disease management.
It sets out a series of steps that local services can take to help ensure that young people attend their appointments as they are handed from childhood services under parental supervision to adult care.
Jackie Cornish, FRCP, national clinical director for children, young people, and transition to adulthood at NHS England, said in a statement that the guidance is "based on the best evidence available."
She observed: "Making sure children and young people understand their condition and know how to effectively manage it through life is one of the most important elements of care, because this reduces the likelihood of complications later in life.
"When young people move services it is one of the most challenging times, and we know from evidence this is often a point when they disengage or lose interest in attending."
Jonathan Valabhji, MD FRCP, NHS England national clinical director for obesity and diabetes, added: "This is a time when the traditional paternalistic model of healthcare delivery doesn't suit all," and therefore the guidance encourages exploration of the role of social media "in the interactions between these young people and their healthcare professionals," he explained.
The guidance was published by NHS England on January 19.
Take the Whole Person Into Account
The most recent National Paediatric Diabetes Audit in England covering 2013–2014 shows that while HbA1c levels are measured in 98% of children and young people with diabetes, only 16% complete the seven care processes of HbA1c, height and weight, blood pressure, urinary albumin and cholesterol measurement, eye screening, and foot examination, as recommended by the health watchdog, the National Institute for Health and Care Excellence.
And in terms of delivery of care and the achievement of treatment targets, routine care is "substantially worse" in younger people with type 1 and 2 diabetes and in people with type 1 diabetes at all ages, the authors of the new guidance point out.
This is particularly important in young people transitioning to adult services, as there is a "strong correlation" between psychosocial issues such as anxiety and depression and increased HbA1c levels and longer gaps between diabetes appointments, they say.
The guidance emphasizes that the wider context of a young person's life should also be taken into account. "As well as dealing with diabetes, [he or she] may also be experiencing other concurrent life changes such as the end of full-time education, a potential move away from parents and carers, university, starting work, making career choices, and experimenting with alcohol, sex, and drugs as well as the interchange between primary and secondary care."
Diabetes is also associated with an increased risk of eating disorders, with rates suggested to be as high as 20% among the adolescent diabetic population. And an eating disorder specific to insulin-using diabetic patients, known as diabulimia, is prevalent among the young.
Series of Steps to Aid Transition
The guidance also stresses the impact of badly managed transition on healthcare expenditure, noting that diabetes complications have been shown to increase the risk of hospital admission and the costs to the NHS fivefold.
"If transition is not effected appropriately, there are recognizable impacts on resources in healthcare and other agencies through repeated nonattendance for planned care, increased use of urgent/out-of-hours care, and increased complexity of need through secondary/avoidable complications."
To improve transition to adult services for young people with diabetes, the guidance recommends a series of measures that take into account the needs of both the patients and their parents and carers. These include:
Agreeing to a joint care plan before transferring the patient to the next service.
Agreeing on goals for the individual patient.
Using social media, email, texts, apps, and Skype to reduce disengagement and promote service uptake.
Monitoring adult care appointment attendance, unplanned hospital admissions, and complications.
Regular HbA1c measurement as part of the key care processes, alongside screening for diabetes-associated conditions and eating disorders.
Diabetes UK Welcomes Guidance
Welcoming the new guidance, Bridget Turner, MA, director of policy and care improvement at Diabetes UK, said it "has been eagerly awaited by healthcare professionals."
"At the moment, we know that far too many young people are falling through the cracks of diabetes care when it comes to transition."
And while the new guidance provides the tools to help professionals, she emphasized that services will need to work with younger people to get the most out of them.
"For example, talking about how they want to communicate with their healthcare team and whether perhaps Skype or email is more useful to them in some instances." Or perhaps other ways of making services more accessible, "such as evening and/or Saturday morning clinics," she said in a statement.
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Cite this: Social Media Helps Young Diabetics 'Stay in Care,' Says UK Guidance - Medscape - Feb 11, 2016.