Researchers Call for Push to More Holistic, Collaborative Care for Young Adults With T1D

Amidst a push for patient-centered care across the spectrum within the health care system, researchers of a new paper are urging for a revamp of how type 1 diabetes (T1D) care is approached for young adults living with the disease.

Resulting from a collaboration between diabetes caregivers and researchers from Ireland and the Netherlands, the paper urged for care that looks beyond the biology of the disease and takes a more holistic approach that takes into account factors like patient preferences, needs, financial status, and other social factors.

They noted that this transformation should come changes at every level, including at the individual level during patient visits, at the organization level in how clinical encounters are organized, and at the national level in both policies and guidelines.

“When designing care plans that are most effective and pursue young adults’ priorities for their life, health and care, we must recognize that people have a finite, and varying, capacity to prevent disruption, to cope, and to adapt,” highlighted the researchers. “Higher workload delegated to young adults and their social networks, sometimes called ‘treatment burden’ leads to reductions in quality of life. This is particularly pertinent to young adults with T1D, as they are expected to implement complicated treatment regimens in which they continuously estimate and administer insulin doses, monitor glucose levels etc.”

Previous insights from young adults have revealed gaps in collaboration between them and their physicians. The group also cited previous work of patients expressing frustration with a focus on HbA1c during clinic visits. In the Australian MILES-2 study, survey findings from over 1000 people with diabetes reported feeling like their clinicians focused only on clinical factors. In the DiaPROM study of young adults, respondents indicated they were reluctant to attend visits when the focus was on clinical factors.

The researchers referenced several initiatives, including the D1 Now study and a Young Adult Panel have been launched to promote collaboration between patients and their physicians. The D1 Now study includes 2 interventions that work to create a collaborative relationship with the patient and to engage in shared decision-making.

The American Diabetes Association have also recognized the alignment of diabetes treatment and patient goals. In recent guidelines, they recommended flexible treatment goals and programs.

“Evaluating efforts of making care fit, both at the point of life and at the point of care, should include evaluating whether care maximally supports and accounts for the young adults’ situation and priorities, and minimally disrupts their lives, loved ones and social networks,” wrote the researchers. “It should include evaluating both the content and the manner of collaboration between young adults and their clinicians. And lastly, it should include evaluating the ongoing style of care; continuously re-evaluating whether care still fits in people’s lives and people’s lives can still be lived in their care plans.”

Reference

Morrissey E, Dinneen S, Lowry M, Koning E, Kunneman M. Reimagining care for young adults living with type 1 diabetes. J Diabetes Investig. Published online May 5, 2022. doi: 10.1111/jdi.13824