A new study by a team at the BD Diabetes Center at Atlantic Health System’s Goryeb Children’s Hospital, headed by Harold Starkman, MD, director of pediatric endocrinology, found that teens with poorly controlled type 1 diabetes can experience anger, frustration and anxiety, fraying the relationships they have with their parents and health-care providers and impacting their treatment and self-management.

A better approach, the team found, was for parents and providers to reduce stress and promote success by simply listening to patients as they described their efforts and struggles. The study was published in the March 2019 issue of the American Psychological Association’s Family, Systems, & Health^® journal.

To control blood sugar levels, people with type 1 diabetes must test their blood frequently and take insulin, which requires diligent monitoring. For teens, this can be especially difficult while managing school and extracurricular activities.

Dr. Starkman and his team, which included Nicole Pilek, MSW, LCSW, the pediatric endocrine social worker at Goryeb Children’s Hospital, and Gloria Lopez-Henriquez, a counselor at CONCERN Behavioral and Management Solutions, recruited nine adolescents between the ages of 13 and 18 who had been diagnosed with type 1 diabetes more than a year earlier and had average hemoglobin A1C levels—a test that measures blood sugar levels over a period of several months—of more than 9.0%, which is well above normal.

The seven girls and two boys, all patients at Goryeb Children’s Hospital, were each interviewed with their parents. Ten health-care providers were interviewed in separate sessions. The interviews revealed significant conflict, potentially impacting treatment. The teens often expressed not feeling understood even as they tried to control their disease, parents’ fears were expressed as anger at their children, and health-care providers distanced themselves by focusing on blood sugar levels instead of seeing patients as busy teens who were doing the best they could.

By acknowledging patients’ efforts and being sensitive to the feelings of all involved, say the researchers, the chances of patients being better able to control their blood sugar increase. “The idea is to transition from a focus on numbers to an understanding that the relationship between patients, parents, and health-care provider[s] is critically important and can motivate patients to be more engaged and improve their health,” said Dr. Starkman. “This kind of listening and understanding can prevent adolescents from dropping out of medical care.”

Recent research reveals that up to 30% of older adolescents whose diabetes is not well controlled don’t transition when pediatric care is no longer appropriate and may return for medical care only after developing complications.

“Dr. Starkman has been trying for a number of years to better understand and address some of the underlying issues involved with adolescents whose type 1 diabetes is difficult to control,” said Walter Rosenfeld, MD, chair of pediatrics, Goryeb Children’s Hospital and Atlantic Health System. “This study shows that effective communication by patients’ parents and the entire health care team should help inform approaches to care for all patients with diabetes.”

The American Diabetes Association recommends that children under age 19 who have type 1 diabetes aim to keep their A1C levels below 7.5%. This is because prolonged periods of high blood sugar can result in serious complications such as cardiovascular, eye, and kidney disease.

The BD Diabetes Center at Goryeb Children’s Hospital is certified by the American Diabetes Association and is nationally recognized for the development of innovative educational and support programs for both families and health-care professionals.