Treatment of Diabetes in Adolescents

Abstract

Background: Diabetes is a significant public health challenge facing the US and several other countries around the world. It is mostly perceived as a lifestyle disease, although type 1 diabetes can be viewed as a congenital autoimmune disorder. Diabetes is increasingly becoming a problem among young adolescents in America, with high prevalence and incidence rates. This study sought to establish the impact of treatment of adolescents for diabetes on their maturity process, demand for independence, parent-adolescent conflict, and their psychosocial development.

Methods: The data was collected through a qualitative, explorative approach that employed focus group discussions as well as in-depth interviews. The FGDs were aimed at collecting data from parents. The data was collected from parents with adolescents that are undergoing treatment for diabetes and those with healthy young adults. The in-depth interviews were used to collect the views and perspectives of the adolescents themselves. In this case, the study collected data from both adolescents with diabetes and undergoing treatment and those without it. This research was designed to ensure that the data collected was representative of both perspectives and, thus, establish a holistic understanding of the impact of diabetes treatment on the chosen themes.

Results: The study indicates that the treatment for diabetes among adolescents has a significant impact on their day-to-day lives, behavior, attitudes, and conduct as well. The study revealed that there is no significant difference between the maturity of diabetic adolescents and healthy ones. This study also demonstrates that the demand for autonomy/independence among adolescents with diabetes and those without it is similar. The research also demonstrates that the level of parent-adolescent conflict is pronounced among parents with adolescents with diabetes and undergoing treatment. In this case, the involvement of the parent is increased because of the need to ensure the young individual takes their mediation and behaves in a manner consistent with the provisions of the physician. As a result, the level of rebelliousness and conflict increases significantly compared to the parents with healthy adolescents.

Conclusions: The treatment for diabetes among adolescents has a significant influence on parent-adolescent conflict, demand for independence, maturity, and the psychosocial development of the young and developing teenagers.

Introduction

According to the CDC, out of the estimated 23 million people with diagnosed diabetes in 2016, around 193,000 were adolescents and children below the age of 20 years. Additionally, around 29.1 million people in the US are living with undiagnosed or diagnosed diabetes. Moreover, the statistics indicate that and around 208,000 people aged below 20 have diabetes that has not been diagnosed. The surge in the frequency of both type 1 and 2 of the disease among young developing people is a clinical and public health concern across the US.

Clinicians, parents, or guardians involved in the treatment, guidance, and taking care of adolescents with diabetes need to recognize that the development process of an adolescent and having diabetes are complicated processes that are strongly linked. At the same time, these two processes are complicated by one another. The adolescent stage of development is comprised of recurring themes of autonomy, achievement, identity, and intimacy. Many adolescents face challenges in each of the themes mentioned above. In the case of diabetic adolescents, these challenges are heightened. Some of the challenges directly conflict with the normative activities and tasks of adolescence (Wiebe et al., 2016; Lennon et al., 2016; Herlitz et al., 2016). For example, adolescents with chronic illnesses like diabetes face increased school absences, pain, medication regimens, disease-related fatigue, altered methods of social interactions, and different methods of parenting.

The analysis of the impact of the diabetes treatment on the development of adolescents is necessary because of the implications it might have on behavior and attitude in the short- and long-term development processes. It might affect the relationship between the adolescents and their parents, their studies, and success in school and later in life (Wiebe et al., 2016; Lennon et al., 2016; Herlitz et al., 2016). As a result, this study's focus is essential in understanding the scale and extent of the impact as well as figuring out possible approaches to mitigate these effects.

The problem of the Statement

Type 1 and 2 diabetes among adolescents introduces significant behavioral and attitude changes to their life. It introduces strict regimens for medication and restrictions in their movement. As a result, this study aims to evaluate the impact of the diabetes treatment among adolescents on their maturity and desire for independence (autonomy). In this case, the study aims to assess the behavioral and attitudinal aspects associated with the development stage of adolescence. In this regard, this study aims to evaluate how these aspects square with significant adjustments enforced on the adolescent as a result of diabetes treatment.

This research aims to analyze the parent-adolescent relationship dynamic and how it is affected by the treatment regimens for diabetes among young people. Moreover, the study sought to evaluate the impact of the diabetes treatment on the psycho-social of the adolescents' wellbeing as well. Therefore, this study focused on: "the impact of the treatment of diabetes on adolescent maturity and desire for independence, parental-adolescent conflict and psycho-social treatment in concurrence with pharmaceutical treatment."

The Review of the Literature

According to Hanna and Guthrie (2003), there is a significant similarity regarding the level of maturity and the desire for autonomy or independence among adolescents with diabetes and those without it. Hanna and Guthrie (2003) further reveal that there is a surge in the "independent decision-making" among adolescents with diabetes compared to the healthy ones. A qualitative study carried out by Dashiff et al. (2006) indicates that the emotional, cognitive and behavioral aspects of autonomy development were similar among adolescents with diabetes and those without it. Additionally, Seiffge-Krenke (1998) reveals that adolescents with diabetes show an increase in the aspect of behavioral autonomy, self-care, and recreational activity. These studies reveal that adolescents with type 1 or 2 diabetes do not show any significant differences in their desire for autonomy and independence from healthy adolescents. These findings are not consistent with the significant changes and stress adolescents with diabetes face when compared to healthy adolescents (Lennon et al., 2016). In this regard, the significant changes in their lives are expected to lead to changes in their desire for autonomy.

According to Young-Hyman et al. (2017), adolescents with diabetes tend to have an increased involvement of their parents in their lives. In this regard, most parents tend to be assertive and influential in the activities that the adolescent takes part in or participates. The defensiveness of the parents sets the platform for increased conflict between them, with the adolescent that is developing a greater desire for autonomy and independence (Herlitz et al., 2016). There is a shared responsibility for the management of diabetes among adolescents. However, the role of the parent and that of the young person is not clearly defined. In this case, the parent-adolescent dynamic changes from one family to another. However, with the strong desire for autonomy among the adolescents and the need for the involvement of parents in managing and administering treatment for diabetes, there is a possibility for conflict between the parent and the young individuals. According to Powers et al. (2017), the increased involvement of parents in the care, management, and treatment of diabetes among adolescent leads to high levels of self-care behavior and psychological health among the young and developing individuals. Bernard et al. (2014) argue that there is a need to establish a balance between the maturation of the adolescents for the responsibility of self-care and the role of the parent in assuming this responsibility. Giving this responsibility to the adolescent too early might affect the adherence levels to the treatment regimen.

According to Goyal et al. (2016), the involvement of the parents in the adolescents' life can also lead to a hindrance of their development. In this regard, too much involvement in the form of rigidly organized and controlled families can inhibit the advancement of the adolescent's sense of maturity and sincere desire for autonomy (Wiebe et al., 2016). The clashing of these aspects often leads to conflict between the parents and the developing young adults.

Methods

This study adopted a qualitative approach. The focus was on establishing the effects of the treatment of adolescents with diabetes on their desire for independence, maturity, relationship with their parents, and their psycho-social development as well. In this regard, the study collected qualitative data through the use of focus groups discussions (FGDs) and in-depth interviews. The research focused on carrying out two separate FGDs, one for the parents and the other for adolescents.

The FGDs were used on the parent cohort for this study. The focus group aimed to discuss the impact of diabetes treatment of adolescents on their psychosocial development, behavior, relationship with their parents, maturity, and demand for autonomy as well. The FGD comprised of 8 parents with children at the adolescent stage. Four of the participants had normal adolescents while the remaining four had young adults under treatment for diabetes. This ensured that the data collected is representative. The approach also allowed the study to compare between adolescents under treatment for diabetes and the healthy ones. This way, the researcher underscored the emerging differences, patterns, and trends as well.

The study also carried out in-depth interviews with the adolescents. In this case, the study interviewed eight adolescents. Four of these had diabetes and were under treatment, while the remaining four were healthy. The aim of this design was aimed at collecting information pertaining to the impact of diabetes treatment on adolescents and establishes differences between young adults undergoing diabetes treatment and healthy ones. This provided a platform for comparative analysis and, thus, the ability to underscore the differences. This way, the study was able to discern the primary effects of treatment on the adolescents (Lennon et al., 2016). The study focused on the major themes for this study including maturity, the demand for independence, parental-adolescent conflict, and the psychosocial development of the adolescents as well.

The use of these two methods allows the study to collect perspectives from the parents and the adolescents as well. This way, through comparative analysis, the study can eliminate the inherent bias within the two groups and focus on the trends and patterns that emerge from the data. This approach enhances the quality of the data collected as well as enhancing the validity and reliability of the study as a whole.

Ethical Considerations

The study focused on the use of human participants, which means that it aimed to focus on adhering to the Armstrong Institutional Review Board guidelines on the protection of human subjects. Firstly, the study sought to have the approval of the Institutional Review Board (IRB) before commencing on the study. Secondly, the research ensured that all participants are well informed regarding the aim of the study. They also were informed of their specific roles as participants and the potential impacts as a result of their participation. Thirdly, by the HIPPA protections and guidelines, the personal information provided by the participants in this study was kept confidential and not released to anyone unless given the express permission by the affected individual (Wiebe et al., 2016). Fourthly, the participation of adolescents in this study means that permission was sought from their parents or guardians to take part in the interviews. In the case of adolescents with diabetes, the design of the interview was carried out in a manner that does not affect their treatment regimen or restrictions on physical activity.

Discussion

The in-depth interviews were carried out at the homes of the targeted teenagers. This was especially important for adolescents who had diabetes and were undergoing a treatment regimen. This approach is essential because it ensured that the interviewees are not exposed to potentially injurious situations. Additionally, carrying the interviews at their homes ensured that they are comfortable. Therefore, this increased the chances of them being candid with the study, which increased the quality of the collected data.

The use of FGDs, especially in the events of disagreements, can lead to the collection of highly subjective data that is likely to distract from the main focus of the research. Additionally, FGDs are hard to control, manage, and analyze. Most parents, especially the ones with adolescents with diabetes, might not be willing to participate because they might find the focus group situation intimidating or off-putting. Additionally, some participants might feel under pressure to agree with the dominant view, which means the data collected might not be representative of their experiences or views of the subject matter. Moreover, the sample size for a standard FGD is eight people. This sample might be too small to be representative of the population. Although this might be indicative of underlying patterns and trends, this study approach might not be sufficient when it comes to policy formulations in the country. A small sample size reduces the validity and reliability of the study significantly. Additionally, the subjective nature of the FGD approach means that the objectivity of the views and opinions expressed is susceptible to the influence of the perceived truths and conventions. This makes it hard to collect reliable data with high validity as well.

The interviewing of adolescents limits this study to 8 in-depth interviews. This is especially the case because of the time-consuming and expensive nature of interview approaches to collecting qualitative data. As a result, this affects the validity and reliability of the study since it might be representative of the population. The focus on adolescent participants means that the collected data might be highly subjective as well as influenced by the external environment (Wiebe et al., 2016; Lennon et al., 2016; Herlitz et al., 2016). This is because, at this stage, adolescents seek recognition, autonomy, and are rebellious as well. Additionally, if the interviews are carried out in the presence of their parents, the parental influence might affect the independence and objectivity of the data collected, especially for the parents heavily involved in the treatment and management of the young individuals' lives and treatment as well.

Conclusion

This study has demonstrated that the treatment for diabetes of adolescents has profound effects on their day-to-day behavior, attitudes, and conduct. However, the study indicates that the demand for autonomy, independence, and maturity aspects are significantly similar in adolescents with and without diabetes (Wiebe et al., 2016; Lennon et al., 2016; Herlitz et al., 2016). At the same time, the involvement of the parents in the decision-making aspects of the adolescents is significantly different between young adults undergoing diabetes treatment and those that are healthy. In this case, parents with diabetic adolescents are more involved in decision-making because they take care of the treatment and management of diabetes (Hanna and Guthrie, 2003; Dashiff et al., 2006; Seiffge-Krenke, 1998). This includes administering medication or insulin and the general welfare of young diabetic adults compared to the parents with healthy adolescents who are allowed relatively more autonomy.

Collecting qualitative data is vital in the subjects concerning the health and interaction dynamics of families. As a result, the qualitative data collected provides insights, explanations, and meanings of significant patterns and trends observed among adolescents, their relationship with their parents, maturity, and focus on independence in decision-making.

The focus on the psycho-social development of the adolescents alongside taking medications for diabetes was not exhaustively evaluated in this study. This is because there is a need to involve the views of professional psychologists (Wiebe et al., 2016; Lennon et al., 2016; Herlitz et al., 2016). In this regard, the psychologist can expound on issues regarding the psychological development of adolescents and how this is affected by the role of the parents, their maturity, and autonomy as well. Additionally, there is a need to explore the impact of peer-to-peer interaction at the adolescence stage and how it affects the development of the young adult (Hanna and Guthrie, 2003; Dashiff et al., 2006; Seiffge-Krenke, 1998). Additionally, there is a need to evaluate the impact of treatment for diabetes on these peer-to-peer relationships and interactions as well.

Additionally, this study could not differentiate between the parent-adolescent conflict caused by the stage of development as observed among healthy participants and the conflicts seen among the diabetic adolescents undergoing treatment. The available literature indicates that the aspects of maturity and demand for independence are similar between adolescents with and without diabetes (Hanna and Guthrie, 2003; Dashiff et al., 2006; Seiffge-Krenke, 1998). As a result, there is a need to carry out a study to reveal the subtle differences in emotions and confrontational nature of adolescents with diabetes who are undergoing treatment and ones which are healthy.

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