Social Support, Access to Care Key Issues for Young Adults With T1D

Young adults with type 1 diabetes (T1D) face a number of challenges, ranging from dealing with physiological shifts that emerge with age to finding ways to pay for their medical care, according to a new study. But they also benefit from social accountability, including from social media.

Those are some of the key takeaways of new research published in the journal Clinical Medical Insights: Endocrinology and Diabetes. The report is based on interviews with 21 patients between the ages of 18 and 30.

Corresponding author Bailee Sawyer, MS, PhD, of Tarleton State University, and colleagues explained that the “emerging adult” period is a time of great change for all people, but it is a particularly meaningful time for patients with T1D for a number of key reasons.

Among them, once young adults hit age 26, they can no longer remain on their parents’ medical insurance in the United States. Risk-taking is also common among the age group, Sawyer and colleagues noted, and people in the age group often experience significant changes in their financial and social situations.

“Emerging adults are in a dynamic flux of change, such as temporary disengagement from professional medical care while transitioning between homes, jobs, school, etc. and also, [they] can be challenging to recruit for the purposes of research,” the authors noted.

Sawyer and colleagues decided to use a qualitative survey to ask volunteers about their diabetes management and the barriers and challenges they face. Most of the respondents (n=19) were female, and the patients had been diagnosed with T1D at a median age of 15.

Following phone interviews, the investigators used grounded theory to generate cohesive themes based on the interviews.

The analysis identified 3 main barriers to diabetes management: physiology, environment, and insurance. In the case of physiology, the investigators said all of the participants said they faced difficulties dealing with changes in their metabolisms, which forced them to make regular adjustments to their insulin dosage.

In terms of patients’ environments, respondents said a lack of social support was a hindrance to diabetes management, but so too were seasonal changes in temperature.

“An interesting barrier was weather, specifically temperature or season of the year,” Sawyer and colleagues wrote. “Participants explained that season of the year affected glycemic variability by increasing difficulty for physical activity or daily walks.”

When it came to insurance, many respondents said their plans did not cover costs such as continuous glucose monitoring (CGM) devices, or, in some cases, even primary care visits.

When asked about strategies they use to manage their diabetes, another 3 themes emerged: medical technology, access to social support, and physical activity. The participants said they valued diabetes management devices; 11 of the participants were using CGM and insulin pumps.

“Participants who were diagnosed with diabetes at an earlier age explained that the progression in medical technology in recent years helped decrease anxiety and fear of the future,” the authors said.

Many patients said they benefited from social support from family, health care providers, and diabetes educators, although they also drew support from social media, where they appreciated seeing celebrities and professional athletes who were open about their diagnosis of T1D, Sawyer and colleagues said.

The patients also saw the benefits of exercise in their diabetes management. All of the participants said they usually took short afternoon walks to counter blood glucose increases.

Sawyer and colleagues said their survey shows that future diabetes education programming should include a focus on fostering social support, but also address topics related to physiology, season, and weather changes.

“In addition, diabetes education management training for family, and other supporters, and an increase in resources for mental health would be beneficial to diabetes management,” they said.

Finally, they said changes in public policy should be made to make it easier for patients to access the devices and medical care they need.

Reference:

Sawyer B, Hilliard E, Hackney KJ, Stastny S. Barriers and strategies for type 1 diabetes management among emerging adults: a qualitative study. Clin Med Insights Endocrinol Diabetes. Published online May 21, 2022. doi:10.1177/11795514221098389