A Focus on Youth
In my previous editorials, I have drawn attention to challenges that face people with diabetes in the United States and abroad. I've written about exciting innovations that have the potential to surmount those challenges, and about our responsibility to act as advocates for change. This month, I wish to highlight the need to better address the specific issues of adolescents and young adults with diabetes. It is a battle that will not be won through advances in technology alone.
In the Oct. 2, 2008, New England Journal of Medicine, Dr. William Tamborlane and the other members of the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group published their findings on the impact of continuous glucose monitoring on blood glucose control in patients with type 1 diabetes. Participants in the study were divided into three groups by age (8 to 14, 15 to 24, and 25 or older), and randomly assigned either to use a continuous glucose monitor (CGM) or not. Only the group aged 25 and over had a significant improvement in average A1C from CGM use. Although the 8- to 14-year-old CGM group did not show a similar improvement, secondary analyses found that more of them had A1Cs of less than 7 percent, and they saw a relative reduction of 10 percentor more in A1C from baseline values. The same could not be said for the 15 to 24 age group. This study once again shows that poor adherence to diabetes management is an obstacle to successful intensive treatment in adolescents and young adults with type 1 diabetes.
Numerous other studies have also confirmed the experience of countless diabetes care professionals working with people with both type 1 and type 2. For example, the landmark Diabetes Control and Complications Trial, published in 1993, found that, compared with similarly treated adults, adolescents had higher A1C levels (8.1 vs. 7.1 percent) and a 60 percent increased risk of severe low blood glucose (86 vs. 54 events per 100 patient years).
I have certainly been witness to inspiring personal and family growth in response to the challenges of young adulthood. But I have seen as many young adults and families struggle with the trials and tribulations of a maturing adolescent coming to grips not only with the attainment of independence and individuality, but with the repeated reminder of vulnerability and mortality that comes with diabetes. Several factors contribute to the difficulties in addressing this issue, including the lack of psychologists and psychiatrists with adequate experience dealing with diabetes in this age group, the frequently poorly orchestrated transition from pediatric to adult diabetes care providers, and the failure of institutions to provide adequate financial resources for needed social services.
It is my hope that more clinical studies will focus on strategies to improve care in this age group. Successfully helping young people will not only improve their quality of life and that of their families but will also have a major impact on the cost of their care.