Young Adults with T1D + T2D Need Personalized Care
Coverage of the ADA Scientific Sessions is brought to you by the ADA x BT1 Collab.
Presentation: Individualizing Diabetes Care and Education for Children, Teens and Young Adults with Diabetes
Speakers at this ADA Scientific Sessions presentation included: Paul McGuigan, RN, CDCES from Case Western Reserve University, Anastasia Albanese-O’Neill, PhD, APRN, CDCES, University of Flordia, Julia Blanchette, PhD, RN, BC-ADM, CDCES, University Hospitals Cleveland Medical Center, Christina Roth, College Diabetes Network, Karen Kemmis, PT, RN, MS, DPT, SUNY Upstate Medical University
This article focuses on the presentations of Christina Roth and Julia Blanchette.
“College is the perfect storm of diabetes and young adulthood,” says Christina Roth, founder and CEO of the College Diabetes Network.
When it’s time to begin college, young adults may be moving far from home and living independently or alone for the first time—while also separated from their daily support system.
Drawing on the College Diabetes Network’s (CDN’s) work and surveys of students, Roth shared recommendations for ways providers can support and empower teens and young adults as they transition from adolescence to adulthood.
Doctor’s visits can be empowering
Providers can structure visits in a way that encourages independence. This might include:
- Speak directly to the young patient instead of addressing the parent.
- Make one-on-one time with the patient a regular part of the visit, instead of asking if they want the parent or caretaker to leave the room.
- Validate their experience and avoid making them feel like they don’t know enough about diabetes.
- Acknowledge that as life changes, they may want to change how they manage their diabetes.
- Initiate conversations around taboo topics like alcohol, sex and drugs to make it clear they have a safe place for these discussions.
- Don’t push options on them, but educate them on what options are available.
Building confidence and support
It’s also important to meet young adults where they are. If they feel like they are getting a report card, they might be discouraged from going to see their doctor. For example, providers can validate that there’s no bad A1c—it’s just a data point that can help inform their diabetes management.
Providers can also encourage peer support to help young adults build up their diabetes support system as they transition away from home. Offering a variety of resources, like social media, blogs, or online platforms is also helpful if someone doesn’t want or isn’t ready to talk to peers.
Preparing for Emergencies
Another way to help young adults feel empowered in their diabetes management is to prepare them for diabetes-related emergencies, like “sick days,” diabetic ketoacidosis (DKA) or severe hypoglycemia.
It’s also critical to discuss how to drink alcohol safely with diabetes: Guide 1 and Guide 2.
Remember, fear and scare tactics are ineffective with young adults, and creating anxiety around a person’s diabetes can have unintended consequences.
When talking about emergency situations:
- Focus on practical strategies
- Talk about what to expect and what to do during DKA, severe hypoglycemia, or sick days (like vomiting)
- Remove judgment—DKA or severe hypoglycemia isn’t anyone’s fault
- Discuss how to explain diabetes and emergency situations to roommates—like signs of hypoglycemia and how to use emergency glucagon
Insurance and cost burdens on young adults
Transitioning to adulthood is hard enough—doing so while managing diabetes can be even more challenging, Julia Blanchett discussed health insurance literacy for young adults.
It’s well known that over the lifespan of a person with type 1 diabetes, the years associated with college and early adulthood, late teens to early 20s, are correlated with the highest average A1cs. This underscores that the demands of young adulthood may make diabetes management more challenging—and that there is a need for more support.
It’s also worth remembering that college students or young adults may not only be learning to manage their diabetes independently and managing their healthcare and healthcare-related costs for the first time.
Over a quarter of Americans with diabetes have rationed insulin due to affordability. Young adults are at high risk of under-using insulin due to cost.
Other insurance-related factors impacting a young adult’s healthcare coverage and diabetes management may include:
- Frequent lapses in coverage
- Navigating the Medicaid system, or not knowing they qualify for Medicaid
- Aging off of their parents’ plans
- High job turnover
- Gaps in coverage
- Having plans with high premiums and high deductibles
- Having a limited understanding of health insurance
For young adults, navigating everything adulthood will throw at them is hard enough—and it can significantly impact their diabetes management. Many of these challenges are the result of shortcomings and failures in our healthcare systems. Understanding the unique burdens young adults can face is important to help them thrive safely with diabetes during this phase of life.
