PowerPoint Presentation

Psychosocial Influences on Diabetes Management in YouthGroup 3: Week 5

Marisa Bouwmeister & Lindsey Stevens+Psychosocial Issues and their Impact on Diabetes ManagementWhen a child is diagnosed with diabetes; the entire family unit is affected and family functioning is impactedPsychosocial issues directly affect and are affected by the complex management of diabetes Diabetes can also present a risk to the psychological well-being of both the child with diabetes and his or her family All of this can lead to significant family conflict which influences how diabetes is managed and can impact overall quality of life+Losses & FearsFreedom for themselves and childFlexibility in their livesSpontanietySupport systemsIntangible losses i.e. loss of the joy of lifeSocial isolation: feeling different to siblings and peersFeeling overprotected/controlled by parentsFeeling self-blame for diagnosis; angerFeeling overwhelmed by the responsibility of managementParentsChildren+Problems faced by parents: How diabetes contributes to family conflictBalancing insulin, food intake and activity with unpredictability of blood glucose levelsFear of hypoglycemia Constant need to supervise young children who are unable to communicate their own needsConstantly advocating for child in school system and communityFear of loss of support from family and friends due to lack of diabetes knowledge and increased needs of childKnowledge that diabetes will be a life long condition+Diabetes burnoutReoccurring and rapid condition that can happen to both parents and childrenSigns can include depression, anxiety, inability to cope, lethargyCan cause some children to mismanage their diabetes i.e. binge eating and omitting insulin/glucose monitoring

+Preventing Burnout: How Baumrinds parenting styles contribute to improved diabetes managementAuthoritarianAssociated with increased family conflictLower levels of adherence to tasks of diabetes treatmentPoor glycemic controlAuthoritativeHigher levels of cooperation Better adherence to tasks of diabetes treatmentAssociated with overall improved glycemic controlPermissiveThese children are classified as least competentParents rarely use control and make no demands

(1)+Diabetes Specific ConflictThere is a direct causal relationship between conflict and poor diabetes management Diabetes specific conflict also has negative impact on childs quality of life

(2)+What the research says

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(3)How can we as health care professionals (HCPs) assist families in reducing conflict?HCPs must examine parents current life situation, style of parenting, knowledge of and feelings towards diabetes and its management HCPs must teach parents importance of language when talking to their children about diabetes i.e. high blood glucose level vs bad blood glucose level and modeling this type of attitudeHCPs should involve children/adolescents when evaluating what is and is not working in current plan of care to help alleviate stress and improve quality of life (dependent on age of child)HCPs can help parents to develop realistic goals and expectations. This builds and strengthens childs self esteem and leads to better diabetes management

+Our goal is to model how to communicate with children with diabetes in a way that provides clear and realistic behavioral expectations around diabetes management blended with supportive and nonjudgmental communications (4)+Strategies for Health Care Providers Employing nonjudgmental listeningEducating support system i.e. family members, teachers, friends, etc.Increasing social support by connecting families in like situations i.e. through support groups, camps, outreach programsProviding care in a culturally sensitive wayAddressing the financial burden and assisting families who may require further support Continually assessing families and childrens psychological wellness and referring them to appropriate mental health professionals as needed

+ Discussion QuestionsYou are caring for an 8 year old newly diagnosed with diabetes. He comes from a single parent family and his mother does not know much about diabetes. What psychosocial influences would you be concerned about and how would you address these to optimize his diabetes management for he and his mother?You are asked to find external support for families living with diabetes. What resources exist in your area to assist families living with diabetes and how would each of these help families affected by different psychosocial influences?You are part of a diabetes team working with A.B. She is a 14 year old living with diabetes for 10 years. She has started omitting insulin and not checking blood glucose levels. Her parents are very stressed and her mismanagement is affecting the whole family. How would you help A.B. and this family?You are part of a team caring for a 5 year old who has been living with type 1 diabetes for two years. Her parents recently separated and they have joint custody. You notice that on the weeks she is with her Mother, her glucose levels are well controlled, however when she is with her Father her levels are high. Her Mother keeps a detailed record of her diabetes management, but her Father finds managing her diabetes on his own very stressful. How would you deal with this situation? +References1. PARENTASTIC.org [homepage on the Internet]. Quebec. Available from : http://parentastic.org/parenting/parenting-styles/.

Tsiouli E, Alexopoulos EC, Stefanaki C, Darviri C, Chrousos GP. Effects of diabetes-related family stress on glycemic control in young patients with type 1 diabetes: Systematic review. Canadian Family Physician. 2013, 59: 143-9.

Laffel LMB, Connell A, Vangsness L, Goebel-Fabbri A, Mansfield A, Anderson, BJ. General quality of life in youth with type 1 diabetes: Relationship to patient management and diabetes-specific family conflict. Diabetes Care. 2003, 26(11): 3067-73.

Anderson, BJ. Family conflict in diabetes management in youth: Clinical lessons from child development and diabetes research. Diabetes Spectrum. 2004, 17(1): 22-6.

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