Response to Comment on American Diabetes Association. Approaches to Glycemic Treatment. Sec. 7. In Standards of Medical Care in Diabetes—2016 . Diabetes Care 2016;39(Suppl. 1):S52–S59

Abstract

BACKGROUND: During adolescence major hormonal, neuro-maturational, emotional and psychosocial changes occur within a relatively short time interval. The additional burden of living with a chronic disease such as type 1 diabetes can further add to the potential for instability. OBJECTIVE: This article discusses the specific management issues facing diabetic patients and their doctors in the teenage years. DISCUSSION: Deteriorating metabolic control of diabetes during adolescence is a relatively common event. Increasing insulin resistance during adolescence is usual for both sexes. Adolescents may increasingly resent parental supervision of their diabetes care, and also rebel against the restrictive nature of diabetes treatment regimens with acceptance of medical advice and adherence to treatment regimens diminishing. Diabetes may interfere with conformity to a peer group and increase the likelihood of risk taking behaviours and fluctuating glycaemia may increase the likelihood of an adverse outcome. Physical risk taking, binge drinking, recreational drug use and unplanned sexual activity all present particular problems for adolescents with diabetes. Subthreshold eating disorders are more common in adolescent females with type 1 diabetes than in their nondiabetic peers. The most helpful thing for a health care professional to do is to maintain a mutually respectful relationship with an adolescent who is struggling to control their diabetes, encourage family support, and praise.