A recent article in Diabetes Care caught my eye: “Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy (DPN) in Youth with Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study.” The article, written by Jaiswal et al, reviews the incidence of DPN and the statistics are sad. Seven percent of youth with type 1 diabetes and 22 percent of youth with type 2 diabetes have some DPN. This adds to the literature supporting a reduction in VO2 max (maximum volume of oxygen used during a high level of activity) in teens with type 1 diabetes, and reduction in left ventricular systolic and diastolic function in adolescents with type 1 diabetes. In my inpatient clinical practice, I have patients with diabetes who have striking complications in their late twenties and early thirties – all of whom have had significant hyperglycemia for multiple years, including during adolescence.
I can remember early in my practice where there was a question of whether hyperglycemia related to long term complications when it occurred in childhood and adolescents. There is no longer a question in this regard.
The evidence is in: diabetes management cannot be ignored and should not be minimized.
The challenge is not recognizing the problem- it is getting at the answer. Teens nationally are one of the most challenging age groups in regard to diabetes management and achieving recommended A1C goals. Their lives are full of activities (sports, debate teams, music) which consume hours of their time and generally bring fulfillment to their lives. In addition, for many it is a time of experimenting with alcohol, drugs and sex. The evidence is in: diabetes management cannot be ignored and should not be minimized.
One additional twist to the story is that other aspects of the life of the teen may also help to reduce the impact of the chronic hyperglycemia. In our busy lives, we can get caught up in the numbers and forget the other aspects of diabetes care.
- Regular exercise: The teen may be willing to ride a bike or walk with a friend. According to the CDC, only one-quarter of U.S. youth aged 12 to 15 years engaged in moderate-to-vigorous physical activity for at least 60 minutes daily (2012 data)
- NOT smoking: If children and teens are living in a smoke-filled environment or have started smoking, working to eliminate this risk is so important!
- Eating healthfully: Lots of vegetables, lean meats, whole grains, healthy fats – working with a dietitian to change the menu or make better fast food choices
- And oh – if they would just bolus for their food!
Diabetes management is always a challenge – but in children and teens it is even more so. Complications from hyperglycemia as well as other lifestyle choices do happen in youth. We need to continue to address the “numbers,” but in addition, remember the other aspects of diabetes care that perhaps may be easier to tackle, more agreeable to the child/adolescent, let the child/teen know we care about all of their choices, and help to lessen (not eliminate) the impact of the elevated A1C.
About the Author:
Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.
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