Adolescence

Optimal care of the adolescent with diabetes

• An environment that

• Allows a trusting relationship to develop between the adolescent and the diabetes care team
• Helps the adolescent to clarify priorities particularly where there is conflict between the needs of diabetes management and the adolescent’s social development and peer activities
• Provides expertise in identifying the physiological changes of puberty, their effect on insulin dose and the frequent difficulties of weight control and dietary regulation
• Provides regular screening for early signs of complications
• Recognizes the emerging maturity of the adolescent, encourages self-reliance and allows consultations to be increasingly directed towards the adolescent rather than the parents.
  Emerging independence is best pursued gradually
  
• Maintains the trust of parents in helping them in their changing role from full responsibility towards cooperative care of the adolescent
• Identifies and recognizes the need for specialized psychological counseling in some situations

• Appropriate styles of education that

• Offer a variety of educational opportunities including open-ended adolescent-orientated discussion and negotiation, age-appropriate written materials, videos, the use of the Internet, peer involvement and group learning, and other activities outside the clinic
• Enables the adolescent to learn from mistakes without moral judgment
• Encourages the adolescent to make decisions about diabetes management with appropriate advice

• Opportunities for teenage diabetes holidays, camps and other recreational activities including

• Information on availability of camps, teenage support groups, discussion meetings and other recreational activities
• Promotion of these activities and ensuring that they are safe, well-organized and have adequate medical input, supplies and emergency procedures
• Information on traveling with diabetes (particularly to foreign countries) and high-activity pursuits

• Organized transition to adult care which involves

• Negotiation and liaison between the pediatric and adult services including, when possible, the organization of joint clinics
• Deciding on the optimal age and stage of development for transition to joint care or transfer to adult care depending on local services and agreements
• Preparing the adolescent for transfer in advance
• Ensuring that there is no hiatus in care at the time of transfer and that the young person is not lost to follow-up care

Young people with diabetes who are lost to follow-up care have a high risk of vascular complications

Recommendation

The diabetes service should have mechanisms in place to identify and locate all young people who fail to attend follow-up consultations

• Advice on sexual health including

• A non-judgmental approach to sexual activity
• Advice on contraception
• Prevention of hypoglycemia during or after intercourse
• Advice on genital hygiene, monilial infection, menstruation and sexually transmitted diseases (STDs)