Transdisciplinary Approaches to Diabetes Care for Children
Written by Yael Shaked
Diabetes is a chronic illness, in which the body either cannot properly use the insulin it
produces or cannot produce insulin at all. Insulin is a hormone that controls the amount of glucose
(sugar) in the blood, which the body requires as an energy source. Diabetes leads to high blood
glucose levels that can cause severe long-term complications by damaging organs, blood vessels and
nerves. If untreated, diabetes may result in death. There are more than 10 million Canadians living
with diabetes or pre-diabetes today [1]. With respect to young children, there are two types of
diabetes which should be taken into consideration: type 1 and type 2 diabetes.
Type 1 Diabetes
Type 1 diabetes (T1D) occurs when pancreas cell which produce insulin, called beta cells,
are mistakenly attacked and killed by the immune system. As a result, no or very little insulin is
released into the body, thus necessitating insulin administration as treatment [1]. A growing number
of individuals worldwide have T1D [2], with approximately 70,000 newly diagnosed cases each
year, an increase rate of 3-4% annually [3]. Only about 5-10% of those with diabetes have T1D [1].
T1D is commonly diagnosed in childhood although it is not uncommon for it to manifest
later in life among adults as well [1, 4, 5]. It has previously been demonstrated that pediatric
illnesses have negative health and mental health implications on adult outcomes. Such implications
include lower levels of education and income among those with illnesses diagnosed in childhood, in
comparison to the general population [6].
T1D is unique among chronic illnesses of children in terms of the complexity of its
treatment. Its therapeutic regimen consists of blood glucose monitoring, insulin administration, diet
management, and physical activity [7]. The degree of family involvement required for the successful
management and prevention of long-term complications is high as well, since diabetes affects
virtually every aspect of daily living. Thus, its ongoing management is often burdensome and often
complicates other challenges faced by individuals with T1D and their caregivers [8]. As a result,
conflict is often observed among families caring for a child with T1D, as parents and caregivers
have much added stress, responsibilities, and demands to their daily regimen [9]. In addition to the
normal developmental tasks and milestones which all children must meet, those with T1D and their
caregivers have additional healthcare priorities that must be dealt with. For young children, these
include, among others, preventing and treating extreme fluctuations in blood glucose levels, coping
with unpredictable appetite and activity, and trusting others with care for the child in settings such
as preschools [10]. Family conflict has previously been found to be negatively related to T1D
treatment adherence [11]. Thus, it is crucial for health professionals take an active role in mediating
these conflicts and supporting individuals and families through various life transitions.
Type 2 Diabetes
Type 2 diabetes (T2D) occurs when the body cannot properly use the insulin that is released
or does not make enough insulin. Depending on its severity, T2D can often be managed through
physical activity and meal planning, but it may also require medications and/or insulin [1].
T2D usually develops among adults and is not typically diagnosed among children [1],
although there is increasing incidence of T2D diagnosis among children above the age of 10 [12].
Factors related to increased probability of a child developing T2D are the same as those seen among
adults. They include overweight and obesity, physical inactivity, a family history of diabetes, certain
ethnicities, maternal gestational diabetes and insulin resistance [13]. As todays childhood population
is becoming increasingly overweight, T2D incidence is expected to rise among younger pre-pubertal
children [12, 14]. Thus, it is crucial to identify children at risk, as early as possible, in order to
intervene and reduce incidence of T2D and to prevent further complications later in life [15].
Transdisciplinary Approaches to Diabetes Care for Children
Written by Yael Shaked
Transdisciplinary Care for Children with Diabetes & their Families:
The traditional medical model of care, considers the physician as active and responsible for
the patient’s care and wellbeing, while the patient is viewed as passive and dependent on the
physician's medical knowledge [16, 17]. This model has received much criticism, especially with
respect to management of chronic conditions such as diabetes, in which the vast majority of the
health care is provided by the patients and caregivers themselves [17]. One improved patient care
model is called the Patient Empowerment Model. This model uses a patient-centred approach and
views the patient as the one in charge of their own healthcare regime [17]. In this model, the patients
and their parents/caregivers are seen as the experts on their own life and individual needs, while the
healthcare team is viewed as the expert on the condition and the resources available [18]. Moreover,
previous literature has emphasized the importance of self-management in pediatric care, indicating
that self-management interventions must be delivered across multiple contexts with interlocking
influences including the individual, family, community, and health care systems (an ecological
approach). These must all be taken into account for the sustainment of self-management and
treatment adherence. Viewing the child with diabetes within the contexts of their life and working
with all of the relevant contexts in a coordinated manner will have greater impact on long-term
health outcomes and healthcare costs [19]. Transdisciplinary healthcare providers are advised to
work within the framework of the Patient Empowerment model, while taking into account the
multiple additional contexts with which a child with diabetes deals, as this serves as an ideal care
model for children with diabetes and their families.
Diabetes among young children is a complex condition, which has both health and mentalhealth implications not only for the children with diabetes, but for their and caregivers as well. Thus,
whenever possible, management of diabetes for this population should be conducted within a
transdisciplinary healthcare setting to include doctors, dieticians, nurses, and mental-health
professionals (such as social workers and psychologists). It is advised for the transdisciplinary team
to work collaboratively in order to try to anticipate situations which may be encountered by the
child and caregivers, specific to each patient. They should be available to assist in finding quick
solutions to any situation that may arise, in order to aid in keeping the children and their families in
full control. By doing so, self-efficacy will be improved and future medical and emotional
complications will be reduced. The interventions should be provided not only to the diagnosed
children, but also to their extended family, as they are all in higher risk of developing diabetes and
complications related to this illness. Various healthcare professional can deal with the different
aspects of diabetes. For instance:
Doctors
Dealing
with
the
medical aspects of the
illness as well as with
the management of
non-routine situations
and their impact on
blood glucose levels.
For instance: stress
from situations such as
family
conflict,
moving to a new
environment, weening
from pacifier… etc.
Dieticians
Nurses
Social & Mental health
Assisting with lifestyle Focusing not only on Being
routinely
changes relating to patient and family, but involved in the care
nutrition
and also on community process to continually
exercising, including caregiver
education monitor coping of
all those involved in within the various child and caregivers.
the child’s care.
settings that the child Varied interventions
participates in, in should be put in place
order
to
increase for newly diagnosed
family
support, children and families
decrease burnout, and and for those who have
reduce missed days been dealing with
that can affect the diabetes on an ongoing
child’s progress and basis as their unique
integration
within needs
differ
these settings.
substantially [9].
Transdisciplinary Approaches to Diabetes Care for Children
Written by Yael Shaked
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References
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