Teens who feel burned out dealing with diabetes face higher rates of complications, study says

Canadian teens and young adults with diabetes are at double the risk of hospital admissions and emergency room visits compared to younger children with the condition, say doctors, suggesting changes in the way care is organized for affected families.

In type 1 diabetes, the pancreas is unable to produce insulin, a hormone that allows the body to use glucose, a sugar, in food for energy. The estimated 300,000 Canadians with the chronic condition having to take insulin injections every day or use an insulin pump to survive.

People with type 1 diabetes also need regular clinical checkups because loss of blood glucose control can lead to serious eye and kidney complications, nerve damage requiring amputations, and even death.

In the Tuesday issue of the magazine The Lancet Diabetes and endocrinologyDr. Meranda Nakhla, a pediatric endocrinologist at Montreal Children’s Hospital, and her team used administrative health data from Quebec to estimate the risk of gaps in routine diabetes care for complications in children under 10 and adults up to 23.

‘With adolescents and young adults, [the complication] tends to be more related to taking insulin off and maybe you’re just feeling burned out by diabetes and just don’t want to deal with it,” Nakhla said.” They may stop taking insulin and end up in the emergency room a day later with diabetic ketoacidosis.”

In diabetic ketoacidosis, there is too much acid in the body fluids and this can lead to the patient needing to be admitted to intensive care. Nakhla said it is often preventable in teens and young adults.

Compared to children younger than 10 years old, the odds of diabetes-related emergency room visits are 1.8 times greater between the ages of 14 and 15 years. The number of visits increased to almost 2.4 times for the 22-23 age group compared to the youngest children.

Take a step back for parents

Part of the challenge, Nakhla says, is that parents need to take a step back from managing all aspects of their child’s diabetes to a more supportive role that gives the child more autonomy.

From the age of two, Max Lagrange’s parents carefully planned their son’s meals and snacks, monitored his blood sugar levels and adjusted insulin doses.

Max, now 15, started managing his diabetes on his own four years ago.

‘I did that as a teenager [got] There are a lot of things to do, school and activities, so it’s probably just finding the time and doing it yourself,” Max said of the challenges.

Max’s mother, Maïa Kapahi, said he is doing great.

“Now he’s wandering around town with his friends, eating alone, being active and having to do all these calculations in his head,” Kapahi said.

But focusing on looking up how many carbs are in a fast-food burger when you’re with friends in downtown Montreal may not be a priority, she acknowledged.

Max has a continuous glucose monitor that constantly alerts him and his parents when he enters a blood sugar danger zone.

“Without that, I think we could have had a lot of situations where he could have ended up in the hospital with low blood sugar or long-term high blood sugar, which could also be dangerous,” she said.

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Continuous glucose monitors are not universally funded by the government in Canada.

Mental health, then diabetes management?

What’s new about the findings from Quebec is that they highlight how gaps in diabetes care visits start at a younger age than previously looked at, said Dr. Rayzel Shulman, a pediatric endocrinologist at Toronto’s Hospital for Sick Children.

Because the brains of adolescents and young adults are not yet fully developed, planning for the future, thinking about the consequences of their actions, and controlling impulses differ from that of their parents.

“Therefore, they are at greater risk for these direct health problems related to their diabetes, such as severe low blood sugars and ketoacidosis,” Shulman said.

Shulman, who is also an adjunct scientist at Ontario’s health research institute ICES, expects the Quebec findings to be applied across the country, although she added that personalization programs are also important.

Nakhla, a physician-scientist at McGill University Health Centre, said previous data show that the risk of depression and anxiety in adolescents and young adults with diabetes is much higher than in those without diabetes.

“Do we need to address the mental health issues first before we effectively address the management of your diabetes?” Nakhla asked.

Shulman Hospital uses text messages to send appointment reminders to adolescents and young adults, as well as monthly diabetes notifications. Recently, an artificial intelligence chatbot was added, programmed with answers from trusted sources.

Kapahi suggested that people who mature also respond to teenagers. “Who are actually… the role models when you’re a teenager, right?”