Healthy Handoff

Helping Teens Take over Diabetes Care

By Cary Estes

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Carol Dashiff, right, is testing a new form of group support and education to help teens with diabetes take responsibility for their own care and to help their parents cope with the anxiety surrounding this difficult transition period.

The stretch of road where adolescence merges into young adulthood is one of the most awkward intersections along life’s highway. For teens, this transition period involves countless lessons to learn and, undoubtedly, mistakes to make. Parents are also in for an education—they must master the difficult art of letting go.

This process can be especially difficult for families dealing with chronic diseases such as type 1 diabetes. Parents accustomed to managing or monitoring insulin injections and regulating diet have to trust their increasingly independent teens to manage more on their own. And since teens with diabetes are just as likely to be forgetful and overconfident as any other adolescent, their parents tend to be especially anxious. This in turn can lead to tension and turmoil during the teen years—especially the middle years, when teens are more and more away from home.

UAB School of Nursing professor Carol Dashiff, Ph.D., hopes to help teens and their families better cope with this difficult process through a new form of group support and education. In a pilot study, she is working with teens age 15 to 17 and their parents in a multifamily format with twin goals: helping adolescents improve their ability to manage their diabetes and helping their parents become less anxious and offer non-obtrusive support.

Family Bonding

“We bring groups of families together and then we separate the parents from the adolescents,” Dashiff explains. “Parents meet with other parents, and the adolescents meet together. They’re mostly sophomores and juniors in high school. They’re starting to become more independent and think about leaving home, and we’re trying to help that transition point.

“Both groups learn about what is normal during this period of time, about what the usual experience is for other parents and other teens in managing their diabetes, what do they do better during the middle teen years, and what areas they continue to struggle with.”

Dashiff and her colleagues help teens focus on the importance of responsibility without the constant help of a parent. “We’re trying to get them to be more appropriately autonomous,” she says. “That does not mean doing what I want to do when I want to do it. It means carrying through on doing what is necessary to maintain good health.”

Mistakes are common in this age group, Dashiff says. “There is a lot of forgetting, so one component of what we do is we teach them memory techniques—how to use associations that will cue them to remember to give insulin or check their blood sugar, or take diabetes supplies with them.”

No More Nagging

Because missing an injection or forgetting to test blood sugar can have drastic consequences, parents often find it difficult to give their children the room they need to grow. Participants in the UAB study receive guidance on how to tread the fine line between caring and nagging in workshops and through follow-up telephone support.

“We teach parents specific techniques that demonstrate ‘autonomy support,’ such as how to acknowledge the adolescent’s point of view, and we practice these techniques,” Dashiff says. “We’re trying to foster a relationship that contributes to the parent being more supportive, as opposed to a reminder-nagger, which is what a lot of us do as parents. We’re not absolutely certain that things are going well when the teen is away, so we do a lot of reminding and nagging. But it’s really critical that the parent has more confidence about the adolescent’s ability to manage.”

Dashiff said this study differs from previous research work on the topic because of the multifamily aspect combined with follow-up telephone support. “The idea is when parents come together, they benefit from the support they get from other parents who are dealing with the same issues, and it is the same for the adolescents,” Dashiff notes. “They learn from one another and can share with one another what they’ve learned while they’re also learning from us.”

Once the study program is completed, Dashiff says, it will be evaluated to see whether it has made a difference in the diabetes management of participating teens. A final assessment should be ready before the end of the year.

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