Diabetes and Children: The Importance of Fitting in

Helping young diabetes patients minimize any perceived stigma while adhering to their treatment.

Just about the last thing on any child’s mind while at school is sticking out like a sore thumb — or maybe make that a sore finger. Young diabetes patients are continually conscious of the perceived social stigma monitoring and managing their condition can bring, and this can negatively impact their treatment compliance.

“Children want to fit in,” says Paul Strumph, MD, an adult and pediatric endocrinologist, and the vice president and chief medical officer of the Juvenile Diabetes Research Foundation. “They don’t want to stick out in the classroom or in sports. So, if their medical condition requires treatment that sets them apart, then there is sometimes a temptation to not take care of the medical aspects of their health.”

And that means avoiding using a glucometer or taking insulin when they might need to. Strumph says a good analogy can be drawn between diabetes treatment compliance and asthma therapy compliance. Devices can be difficult and the regimens can be complex. Children don’t want to break away from an activity to take their insulin or use their inhaler.

In fact, a child might be self-conscious to the point where he or she doesn’t address low blood sugar by grabbing that handy snack or box of juice out of his or her backpack, and that, of course, risks even lower blood sugar, possibly to the point of hypoglycemia. (Even though probably just about the last thing a child wants would be a serious reaction, and the ensuing shot of glucagon and ambulance ride that would most likely entail.)

That said, HME providers and other providers can help young diabetes patients monitor their conditions in such a way that they fly under the social radar on the playground and in the halls of their school. Strumph says this starts with getting buy-in from the patients.

Getting Buy-in

“It’s not enough for the physician to say ‘this has to be done,’” he says. “The person on the other end of the conversation has to agree that treatment goals are their priorities, too.”

That means getting agreement regarding treatment expectations and any concerns or fears related to the treatment, Strumph says. The goal is to essentially customize the treatment program to the patient and to his or her situation and environment, he explains. For instance, it might be preferable to have somewhat looser glycemic control guidelines for particularly stressful times of a child’s day.

The key is to sit down with the patient and ask them about the factors that make adherence a problem, Strump advises. The issue could be as simple as they might desire to use an insulin pen, rather than a syringe, because of the image associated with a syringe.

This also benefit from getting the family involved, too, since parents and siblings can often reinforce and facilitate compliance. Of course this means making sure the treatment is one that they can assist. Ultimately, it is an issue of give-and-take.

“You really need to talk about it,” Strumph says. “Maybe the physician’s treatment goals are unrealistic for that family because of stress in the family or other factors that for the short term might have to take a higher priority than perfect adherence.”

And once that treatment is outlined, Strumph says custom instructions should be written out clearly and concisely and kept in places where they are accessible for reference during the day. This includes instructions on how to adjust insulin levels based on blood sugar readings for Type 1 patients.

The Right DME Can Help

When kids are involved, keeping treatment simple can go a long way toward minimizing any social concerns young patients might have, and maximizing their compliance. There can be many instances where a simpler program will foster better patient compliance than a more complex regimen — even though, in the best possible world with excellent patient control, the more complex regimen might yield perfect compliance, Strumph explains.

This is one place advances in diabetes DME can really help. Autocoding is a perfect example. Instead of patients having to set their glucometers so that they correctly read a test strip, many glucometers can automatically calibrate themselves to read the strip. This, along with glucometers that require a smaller sample, can go a long way toward simplifying the process and minimizing any errors on the part of young diabetes patients.

“If [young patients] remember to actually test their blood sugar, they want to get it done as quickly as possible, so no one in the school hallway sees them testing their blood sugar,” Strumph says.

So glucometers that provide features that can young patients keep their diabetes on the “down low” can be a boon to patients who don’t want to draw attention to themselves. This includes glucometers that deliver quick, accurate blood sugar readings, and offer the ability to keep things on the QT, such as glucometers that can be set to run silent so that they don’t beep at every step in the process.

Likewise continuous glucose monitors can help add more automation and simplicity to the process since they provide near-constant feedback on whether or not glucose is in the acceptable range. Continuous glucose monitors also help young patients see trends in their blood sugar so that they might be able to predict when they might need to eat snack in anticipation of certain activities, Strumph explains.

“If you have a continuous glucose monitor and your blood sugar is in an acceptable range, then maybe you would eat the snack when you’re supposed to, because you’re not scare of a really high blood sugar occuring,” he says. “Also, the continuous glucose monitor could serve as a safety net because it can alarm when the patient is going low.”

However, he notes that patients need to remember that “the monitors are not currently approved to base insulin dosing decisions on; you’re supposed to check a finger stick before taking insulin.”

Product Knowledge

In the end, having knowledgeable HME providers who can help patients find products that are tailor-made for their treatment can be a boon in helping young patients comply.

“Physicians aren’t always as good at customizing the solutions for the individual person,” he says. “They can tell a person what insulin they should take in what circumstances, but whether it’s a syringe or pen, and if it is a pen, then what kind of pen, is usually not an area of expertise the physicians have.

“The ability of people to put the meters and pumps in their hands and operate them is so helpful in deciding what is the right product,” Strumph continues. “So, if there is a possibility of looking at this durable medical equipment side-by-side and comparing their attributes with what the person wants, with the input of a provider that is familiar with the different products they are selling, then that would be great.

“To be knowledgeable about the products that you’re selling allows patients to pick products that are closest to their needs.”

This article originally appeared in the March 2009 issue of HME Business.

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