For teenagers who have diabetes, the responsibilities that come with growing up are magnified by the demands of living with a chronic disease. Tasks that were once handled or at least supervised by a watchful parent—ordering supplies, shuttling to and from doctors' appointments, checking blood sugar levels, and eating a balanced diet—are handed off as young adults become accountable for their own health.
Even adults struggle to keep up with it all, and research shows the road to complete self-sufficiency can be a rocky one for young people with the disease. In October’s “Diabetes Watch” column, Pharmacy Times reported on a Pediatrics study which found that children with types 1 and 2 diabetes routinely miss 2 critical screenings: biannual A1C testing and annual eye exams. The problem was more common in older teenagers than in younger children, suggesting gaps in care as patients enter adulthood.
To bridge those gaps, the National Diabetes Education Project (NDEP), part of the National Institutes of Health, created Transitions, an online toolkit that includes checklists, timelines, and other educational materials that form a roadmap for the switch from pediatric to adult care. As diabetes educators and accessible health professionals, pharmacists are equipped to use these and other tools to provide stability and continuity for young adults and their families during each stage of this rite of passage.
Slow and steady
Although patients typically stop seeing their pediatrician between the ages of 18 and 21, experts say the transition process needs to begin much earlier, especially when chronic disease is a factor. NDEP recommends that parents begin discussing the transition 1 to 2 years before their child’s first visit to the adult care provider. During this time, parents should encourage teens to take over some responsibilities, such as making appointments and filling prescriptions.
Adolescent medicine specialist Garry Sigman, MD, of Loyola University Health System, says this can be challenging for parents, but it’s worth the effort. “Parents want to be helpful, and honestly, it’s often easier and less time-consuming to take care of a child’s medical needs than to teach them to do it themselves,” said Dr. Sigman. independence comes slowly and it’s important to give your children the tools they need to care for themselves as adults.”
Pharmacists can ease the burden on parents by educating young patients about their medications and how to take them, offering self-care strategies to keep blood glucose in check and prevent complications, and answering any questions teenagers may have about their care. By establishing themselves as a trusted allies and members of the health care team, pharmacists can also build relationships with young diabetes patients that last well into adulthood.
Money talks: Advice for parents
The years prior to the switch are an ideal time to introduce teenagers to financial matters related to their care and health coverage, according to Dr. Sigman. In the Pediatrics study, researchers speculated that lack of insurance was the culprit behind missed or skipped diabetes tests. Lower family income was also associated with less frequent screening. “Even among individuals with diabetes who have insurance, we know that the copayments for healthcare services, medications, and diabetes supplies can be difficult for some families to manage,” a study author told Reuters.
To help young adults with diabetes understand insurance issues and health costs, experts at Loyola University Health System and NDEP have these recommendations for parents:
Ask teens to take charge. Parents should encourage teenagers to carry their own insurance card, make insurance claims, and review health insurance statements and bills—whether or not they make payments themselves.
Call a family meeting. Families should sit down together to discuss their child’s current insurance status and address any circumstances that could cause it to change abruptly, such getting a full-time job or heading off to college.
Tally out-of-pocket expenses. Drawing up a budget that accounts for the cost of prescriptions and supplies can help young people understand how diabetes impacts their financial lives—from career choices to day-to-day purchases.
Above all, parents should see their child’s teen years as an opportunity to prepare them for the challenges ahead—and remember that practice makes perfect. “The adolescent period should be used to practice and learn skills needed for selfcare,” says Dr. Sigman. “Let the teen have a say in the treatment plan, help your teen understand his or her prescribed medications and how to use them, and let your adolescent be the primary communicator with the doctor.”