Search

Only 17% of adolescents with type 1 diabetes achieve glycemic control targets (1), and many are at risk for psychological concerns (e.g., depression, anxiety, and diabetes distress) (2,3), diminished quality of life (4), and the development of diabetes complications (5,6). Psychological functioning and the quality of parent-child interactions can heavily influence self-management in adolescents with type 1 diabetes and are therefore among the greatest concerns of adolescents with type 1 diabetes, their parents, and their health care providers (HCPs) (7). However, conventional models of care are ill equipped to address these issues effectively. Approximately 30% of diabetes teams do not have access to mental health providers (8), and teams with access to such professionals struggle to efficiently incorporate them into routine care (9). The increasing incidence of youths diagnosed with type 1 diabetes each year (10,11), coupled with the limited supply of pediatric endocrinologists (12) to treat these patients, exacerbates these challenges. Thus, there is a need for novel and alternative models of health care delivery for adolescents with type 1 diabetes that address behavioral and psychological barriers to diabetes management and dietary management and are more time-efficient for diabetes clinicians. Multiple models for integrated pediatric care of type 1 diabetes exist and aim to meet American Diabetes Association (ADA) guidelines for care (13). The ADA recommends a collaborative care approach among HCPs and families, including the incorporation of shared decision-making, medical nutrition therapy, and psychosocial support during routine ambulatory care visits (13). These treatment teams may include endocrinologists, advanced practice nurses, physician assistants, dietitians, certified diabetes care and education specialists (CDCESs), social workers, and psychologists. Multidisciplinary care, typifying much of type 1 diabetes care in the United States, engages several disciplines, but each discipline stays within its boundaries, and knowledge of other disciplines …

Editor's Note: This article is adapted from the address Dr. Wysocki delivered as the recipient of the American Diabetes Association’s Richard R. Rubin Award for 2018. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Wysocki delivered the address in June 2018 at the association’s 78th Scientific Sessions in Orlando, Fla.

Mere mention of the words “teenager” and “diabetes” in the same sentence sends shudders down the spines of parents and health professionals alike.1 But the fact is that most families of teenagers with diabetes do a creditable job of managing it, and most teenagers will go on to lead full and satisfying adult lives despite the extra burdens it imposes. What are the elements of parent-adolescent relationships that lead to these favorable outcomes? Why do some families seem to survive the teen years unscathed despite the challenges created by diabetes? What can health professionals do to help more families of teenagers achieve long-term success in living with diabetes? In this article, I will try to address some key features of family and health care environments that differentiate among those adolescents who succeed in life despite diabetes and those who do not. Some of the ideas I will express are opinions based on careful consideration of relevant research on adolescent development, particularly regarding the internalization of prosocial values, rather than on studies that have been done specifically with adolescents with diabetes.2 It hurts to watch someone you love make bad decisions that could lead to serious, but preventable, problems. As teens with diabetes grow up, parents must respond when their children make errors in judgment, behave impulsively or irresponsibly, or are dishonest about their diabetes self-management. These are all common, perhaps necessary, parts of the process of growing up with diabetes. Because diabetes responsibilities turn up in just about every aspect of daily life, the ways in which families and health professionals respond to these inevitable situations are probably important influences on adolescents’ psychological adjustment to the condition. It is all too easy for adults to express caring and concern for their teenagers in ways that may be interpreted …