Teens with Diabetes by Michael A. Harris

Author:Michael A. Harris
Language: eng
Format: epub
Tags: ebook
Publisher: American Diabetes Association
Published: 2014-06-15T00:00:00+00:00

8

Repeat DKAs

It is well known that adolescence is the most difficult time to control blood glucose levels, and despite the fact that most teens with diabetes weather this period in their lives without excessive hospitalizations for DKA, a subgroup of teens evidence a major deterioration in their metabolic control and are repeatedly hospitalized for DKA. Typically these teens maintain double-digit A1C values. They are often referred to as “frequent fliers” or “train wrecks” by members of their diabetes treatment team. Such teens are often difficult to treat, resulting in increased time commitments and stress for their health care providers. Furthermore, because of the chronic and difficult-to-treat nature of diabetes, substantial costs are associated with the management of young people with diabetes.

What is known about this subgroup of teens and their families is that they are buried under a mound of life stressors and challenges that make it difficult to properly attend to diabetes care. For example, in a sample of 20 teens with diabetes who were hospitalized repeatedly for DKA (three times in the past 6 months), a disproportionate number lived in single-parent families and 63% of the teens’ parents were either unemployed or underemployed (Harris 2013a). Moreover, the teens and their parents suffered from psychosocial, behavioral, and mental health problems at a much higher rate than did families of teens with diabetes not repeatedly hospitalized for DKAs (Harris 2013a).

Many of the hospital admissions for DKA are avoidable. In this subgroup of repeatedly admitted teens, DKA episodes are rarely due to illness or other uncontrollable factors. Instead, the teens’ psychosocial circumstances contribute to poor adherence, poor access to care, and poor metabolic outcomes. Intensive behavioral health interventions that address teens with poorly controlled diabetes have proven effective in improving adherence to treatment, improving overall psychosocial functioning, and reducing avoidable hospitalizations (e.g., Harris 2003, Wysocki 2007, Ellis 2008a, Harris 2013a). However, many youth do not have access to integrated care with behavioral health professionals who specialize in the care and treatment of youth with complex medical conditions. Either because families live too far from tertiary medical centers that provide specialized care to youth with diabetes or because youth are underinsured, getting the necessary specialized care is often difficult, placing these youth at high risk for deteriorating health and repeated hospitalizations due to suboptimal adherence.

Besides being a symptom of our poorly organized health care system and causing significant problems for health care providers, patients, and their families, the lack of multidisciplinary integrated care for youth with diabetes creates a huge financial burden on both the health care system and the insurers (Harris 2013a).

With adherence rates for most complex medical conditions hovering around 50%, but plummeting as low as 10% for certain health behaviors (DiMatteo 2002), nonadherence costs the U.S. alone as much as $100 billion annually (Osterberg 2005). It is also estimated that upwards of 50% of hospitalizations for children with complex medical conditions are due to poor adherence to treatment. While the mean cost of the hospitalization of a

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