[Edna Siima Majaliwa is a Paediatrician and Paediatric Endocrinologist at Muhimbili National Hospital in Dar es Salaam, Tanzania. She is a collaborator in the META trial for the study of metformin treatment for diabetes prevention which provided initial data for the INTE-AFRICA project and the greater RESPOND-AFRICA research lines.]
The World Health Organization defines adolescence as the ages between 10-19 years, which goes from the start of puberty to becoming a young adult. This growth stage is considered a tough moment in one’s lifetime due to rapid physical growth and maturity in addition to mental and social growth. During this period, individuals have different developmental and health needs, and it is at this stage that they become independent to manage their emotions, reasoning, social skills, relationships, and overall capability of logical and rational thinking. This World Adolescent Week, we highlight one problem affecting adolescents: diabetes.
This World Adolescent Week, we highlight one problem affecting adolescents: diabetes
Adolescents and diabetes
Diabetes consists of a number of disorders, characterised by chronically high blood glucose levels resulting from defects in insulin secretion and action, or, in some instances, both. It is among the diseases categorised as non-communicable diseases (NCDs) –or non-infectious diseases– and is caused by different mechanisms and risk factors. There are various types of diabetes, however the most common ones amongst adolescents include type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).
Photo: INTE-FRICA project - Specialized diabetes health center in Uganda.
Common types of diabetes
Type 1 diabetes mellitus
Also known as insulin dependent diabetes mellitus, T1DM is a condition where the pancreas fails to produce enough insulin, a hormone that enables sugar to enter cells. The cause is unknown, although environmental factors like viral/bacterial infections and chemical toxins may be involved. T1DM results from an autoimmune reaction towards the β cells of the pancreas, leading to impaired insulin production. T1DM commonly begins in childhood or adolescence, however all age groups may be affected. It has no cure and, therefore, people with T1DM manage their blood glucose levels through insulin injections, balanced nutrition, and a healthy lifestyle, in order to minimise the possibility of complications.
Type 2 diabetes mellitus
Also known as adult onset diabetes mellitus, T2DM is caused by either the pancreas failing to produce enough insulin or resistance of the cells to insulin, or both. It used to affect mainly adults; however, since obesity rates in children are increasing as a result of improper nutrition and sedentary lifestyles more and more children are being affected. Other risk factors for diabetes include hyperlipidaemia, hypertension, and a family history of T2DM. Treatment includes balanced nutrition, a healthy lifestyle, and medications such as sulfonylureas, which increase the amount of insulin released from the β cells of the pancreas, and biguanides, which reduce the production of glucose during digestion.
Management of diabetes
Diabetes can oftentimes lead to complications, particularly if not managed correctly, and may have a multisystemic effect, thus requiring multidisciplinary management. The main aim of management is to avoid acute decompensation, prevent/delay complications, reduce mortality, and maintain good quality of life.
Among adolescents, the most common form of diabetes is T1DM but, as mentioned, T2DM is also on the rise. Living with diabetes makes a person vulnerable to a variety of health issues since their immunity is impaired and their lifestyle has to be adapted as there is a higher risk of complications such as renal, eye, and cardiovascular disease, compared to the general population. Unfortunately, adolescents are often overlooked by health care systems because they are not classified as adults to be attended by an internist nor children to be attended by a paediatrician and are hence stuck in between.
Unfortunately, adolescents are often overlooked by health care systems because they are not classified as adults to be attended by an internist nor children to be attended by a paediatrician and are hence stuck in between
A multidisciplinary team is needed to care for people living with diabetes, particularly among adolescents so as to help empower them to lead an independent life. Diabetologists (one specialised in adults and one in paediatrics), nurse educators, nutritionists, psychologists, sociologists, and physical activity instructors are needed in attending to adolescents with diabetes.
Diabetes in the developing world
Multidisciplinary teams are, more often than not, missing in the developing world, particularly for adolescents. This gap in diabetes care management places a strain on already limited health care systems and therefore the available team needs to have a breadth of knowledge in all categories (e.g., psychology, sociology, foot care, nutrition, and general education on living with diabetes).
Furthermore, health care providers should re-evaluate the balance between independent self-care and intensely supervised care provision in every clinic visit so as to empower adolescents to become more independent in their diabetes management. Adolescents need support and education on diabetes self-care management, which should be individualised depending on the stage of maturity, empowering them to take better care of themselves, according to the standard guidelines available in each region.
Adolescents need support and education on diabetes self-care management, which should be individualised depending on the stage of maturity, empowering them to take better care of themselves, according to the standard guidelines available in each region
Diabetes places a large burden on adolescents. Furthermore, this is an age where they tend to experiment in ways that may negatively impact their health, just as their peers without diabetes would. At this stage peer pressure is an influential part of life and may lead to experimenting with things like cigarettes, drugs, alcohol, partying, and sexual activities. It is therefore important to listen to them at every visit and have an open dialogue about their risks and behaviour, and to provide them with information so that they are better equipped to deal with these situations. Providing continuous assessment and support of psychosocial issues during routine visits is important in addition to family involvement throughout this process. These can both optimise blood glucose control and prevent further complications.
In the context of sub-Saharan Africa, most clinics are not adapted or structured to be “adolescent friendly” and may even isolate adolescents instead of bringing them together to tackle the issues at hand. During this World Adolescent Week, health care providers globally should strive to create adolescent appropriate environments to take care of this overlooked group living with diabetes. This may help to potentially reduce or delay complications associated with this condition.
In the context of sub-Saharan Africa, most clinics are not adapted or structured to be “adolescent friendly” and may even isolate adolescents instead of bringing them together to tackle the issues at hand
As health care providers, we must address the challenges that adolescents face and give them the attention they deserve individually, since some of them are more vulnerable than others and their development has implications in their diabetes management during adolescence and throughout their lifetime. We must remember that changes during adolescence affect the way people think and act. Hence, educating and empowering adolescents and their families during this time will optimise their diabetes management and prevent complications as they grow into adulthood.