Families Coping With a Child With Type 2 Diabetes, Essay Example

The purpose of this paper is to explore and describe the impact of type 2 diabetes (T2DM) in youth from the perspective of family systems nursing. the successful management of diabetes, unlike most chronic diseases, is dependent on the patient making complex decisions regarding nutrition, lifestyle, medications and symptoms based on the recommendations of the health care provider. Diabetes is largely a self-managed disease. Childhood diabetes requires parental supervision and involvement to ensure immediate safety and prevention of long-term complications. Negotiation and delegation of responsibility is necessary during the turbulent period of adolescent.

The increased prevalence of T2DM of youth is closely related to increasing rates of childhood obesity and is often in multiple family members. It is most prevalent in African American, Hispanic, and native youth. Adolescents with T2DM exhibit significant physical, socioeconomic, and psychosocial differences than adolescents with type 1 diabetes (T1DM) This population will experience considerable physical and emotional challenges during their lifetime. The nurse will encounter this population in a variety of settings and will benefit from understanding the role of family system and evidence based research in the management of this disease. Research shows that the family is a significant influence in whether or not children with type 2 diabetes are compliant with their diabetes care management. Children are impressionable and will often only do what other family members and guardians do or allow them to do.

Analysis of the Population

According to the National Diabetes Information Clearinghouse, 25.8 million people in the U.S. have diabetes, which is 8.3 percent of the entire U.S. population. In addition, it is estimated that approximately 18.8 million people in the U.S. are actually diagnosed with diabetes and about 7.0 million people with the disease are undiagnosed. Among these, more than 215,000 children and adolescents are diagnosed with diabetes each year. For type 2 diabetes, the diagnoses are approximately 4% per 100,000 children under the age of 10 and 8.5% per 100,000 children 10 years or older. Type 2 diabetes in children under the age of 10 is rare; however, for children 10-19 years old, the incidence rate is higher, particularly among children in minority populations (NDIC, 2011).

Type 2 diabetes used to be mostly an adult disease. Until the last decade, type 2 diabetes in children and adolescents was considered unusual. However, evidence shows that as many as half of newly diagnosed diabetes cases are youth between the ages of 10 and 19. The disease is now common in children and teenagers (Rosenbloom). This is directly related to the growing number of children and teenagers who are obese or have tendencies to become obese, which is a major risk factor for type 2 diabetes. It is reported that increased type 2 diabetes rates have paralleled increased pediatric obesity rates in the U.S., over the past two decades. Obesity in children and teenagers is caused by excess caloric intake and low physical activity (Nathan, 2007). This is also true for adults, as obesity is an issue for people of all ages (Diabetes, Type 2, 2008). Diabetes is a disease that often runs in families. Statistics show that the disease is more prevalent in children of minority groups such as Native-American, African-American, Mexican-American and Asian-American heritages, due to higher insulin sensitivities than those of non-Hispanic Caucasian children (Nathan, 2007).

Over the past three decades, the incidence of childhood obesity has increased more than 100%. According to a study by the National Health and Nutrition Examination Survey 22.6% of children, 2 to 5 years old and 31% of youth 6 to 19 years old in the U.S. are at risk for being overweight (Hannon, Gutham, & Arslanian, 2005). Consequently, overweight children are at risk for becoming overweight in adulthood, and being overweight is a significant risk factor for diabetes. Furthermore, it is reported that 74% to 100% of children with diabetes have a family member with the disease (Nathan, 2007). Additionally, with type 2 diabetes, what runs in the family is also likely the eating and lifestyle habits that contributes to the familial status of the disease. Other health and social systems problems are related to complications of diabetes in children, such as kidney disease, hypertension, liver disease, retinopathy, cardiovascular disease, or polycystic ovary syndrome (Hannon, Gutham, & Arslanian, 2005). Clinical discussion about diabetes is highlighted in the following literature review.

Review of Clinical Literature #1

Diabetes Spectrum published “The Family Approach to Diabetes Management: Theory Into Practice Toward the Development of a New Paradigm” by Joe Solowiejczyk.

Purpose

The purpose of this article is examining how family make-up is directly related to children’s and adolescent’s diabetes management in the household. The article highlights the best approach for educating and training families with diabetic children to manage the disease.

The article begins with stating that most children with diabetes live in households with other diabetics, possibly three or four other family members with the disease. Ongoing studies focus on determining how family functioning influences how a child’s diabetes is managed, based on behavior and metabolic control (Solowiejczyk, 2004). In other words, family members play a significant role in whether or not a child with diabetes is eating properly and being proactive, as well as active, with other necessary protocols to manage the disease. Often, diabetic children are non-compliant with medical protocols, and this results in mismanagement of the disease, which could lead to serious consequences.

Theoretical Concepts

Theoretical concepts in the article include diabetes management and reducing the possibility of complications from the disease and few intervention models motivate adolescents and teens to better diabetes management. The article highlights the importance of children and adolescents being compliant with consistent self-management of their diabetes. Additionally, the importance of empowering children with self-confidence and competence about diabetes management is noted. However, it is also noted that it is important to remember that children may not be as responsible as some adults may.

According to the article, interventions such as educational classes, support groups, and summer camps that emphasize the dangers of non-adherence and non-compliance to medical management of diabetes are not effective in the long-term (Solowiejczyk, 2004). This is likely due to these children and adolescents reasoning that they feel fine and are able to do what the peers do and take feeling fine for granted, not realizing the ongoing and cumulative damage they are doing to their bodies.

Application to Clinical Practice

Regarding clinical practice, the article points out an effective model for managing type 2 diabetes in children and notes their ages must be taken into consideration, as well as any issues with their growth, development, cognitive reasoning and family make-up. The model used in the study is called the FADM Model and it is designed to assess relevant criteria relating to family-based interventions for diabetic children. This model also takes into consideration the likelihood that families will suddenly change their ways and become 100% compliant. The purpose of the FADM Model is changing noncompliant behaviors regarding diabetes management and assisting families in helping their children remain compliant with healthy protocols (Solowiejczyk, 2004).

The article gives accounts of case studies regarding the FADM Model and notes that the concept suggests that engaging children and adolescents in their own care and soliciting the involvement of their parents results in better self-management of their diabetes. It is noted that clinicians using the FADM Model are not required to get into the child’s feelings about self-care and management; however, they are to assist the parents in understanding the importance of controlling their children’s diabetes. The idea is the children can hate being compliant all they want, as long as they just do it. Healthcare professionals and parents cannot give in to the children not liking doing the things they need to do to be healthy (Solowiejczyk, 2004).

Clinical assumptions regarding FADM include taking steps to encourage structural changes in the children’s lives that actually changes their behavior patterns. It is noted that behavior is directly related to the family and the rules, needs and expectations within the family unit. Additionally, the entire family is considered the patient who is responsible for the self-care of the diabetic child, adolescent or teenager. The primary objective of the FADM Model is educating and counseling families to help them regroup and establish better roles and responsibilities for diabetes management in the household.

Results of the study show that the FADM Model approach is successful in eliminating non-compliance of diabetes management, and positive results with behavior, responsibility, blood tests and parental satisfaction are reported. This is definitely a strength of this approach. However, it is suggested that more research is needed for exploring how FADM could be used to assist with standard diabetes cases. Additionally, it is noted that previous research should be expanded upon to further emphasize the influence of family in diabetes management. This is particularly true for type 2 diabetes management. Lastly, limitations include the need for more training for healthcare professionals for integrating a family approach to clinical practice (Solowiejczyk, 2004).

Review of Clinical Literature #2

Chesla, C. A., Fisher, L., Mullan, J. T., Skaff, M. M., Gardiner, P., Chun, K., et al. focuses on Family and Disease Management in African-American Patients With Type 2 Diabetes.

Purpose

This article explores features of African-American families regarding type 2 diabetes and reports that African-Americans are about twice as likely to be stricken with type 2 diabetes.

Theoretical Concepts

In addition, this minority group has a higher incidence of complications from the disease, such as stroke, heart disease, kidney disease and death at younger ages, than Caucasian Americans. This is based on current research and is statistically significant to suggest that more culturally-approach education, training and awareness is necessary to change behaviors associated with African-Americans and diabetes management. The study used questionnaires and interviews as a research method for identifying approaches to affect changes in the behaviors of African-American diabetes concerning management and care. Additionally, risk factors related to the higher incidence of African-Americans and diabetes include diet, education about disease management, and trust issues related to healthcare professionals. It is also noted that African-Americans need to under the stand all of the consequences of not managing the disease, such as financial consequences as well as health consequences (Chesla, et al., 2004).

Theoretical perspectives in this article also highlight the fact that many African-Americans value their interdependence and that encouraging families, as a whole, to do better with diabetes care compliance is important. It is noted that success in the area of curbing the incidence and prevalence of diabetes in African-Americans depends on controlling family influences when it comes to health practices with type 2 diabetes.

Application to Clinical Practice

The article notes that the research consisted of assessing 159 African-American participants with type 2 diabetes regarding family life, as it relates to structure, values/views, and emotional management. Additionally the study explored the patients’ status related to disease management, including behavior towards management, morale and compliance with regulating glucose consistently. The study participants were screened and assessed via interview questionnaires and face-to-face interviews to ascertain the research data for results compilation.

The research measured family structure and family lifestyle, which encompasses the family worldview, emotion management and family organization (Chesla, et al., 2004). It is noted that family is very important in the African-American community and family has a direct influence on health behaviors, as these behaviors may run in the families. These behaviors include those related to conflict, intimacy, anger, loss, etc. These emotions and behaviors may influence familial support of a diabetic family member in such cases. This is significant to understanding how to educate African-Americans about the importance of compliance with diabetes management, at all times, even when conflict arises.

The research also measured the morale of African-American diabetics regarding disease management, as well as general health and mental status. This also related to whether or not the patients had positive behavioral traits toward diet and exercise, which are two important aspects of diabetes care and management.

Results of the research show, in relation to the measures above, the average patients were middle-aged, post-high school educated with low incomes. Additionally, most of the patients were married women (60%) who were diagnosed since about 7.7 years. The most significant barriers to disease management noted in the research were related to morale, unresolved conflict and family coherence. These issues were noted to possibly serve as discouragements to diabetes care. The research shows a correlation between family emotion management and disease management, and this is significant in African-American families. This suggests the necessity for more focused interventions toward family relationships in African-American families regarding diabetes, as these issues affect the children in these families as well, particularly if the children are stricken with diabetes.

Limitations of the study included limited information about the success of these approaches. In addition, findings should be carefully considered due to further study needing to be done factors and influences other than those mentioned in this research. For instance, exploring neighborhood, segregation, healthcare access, etc. need to be examined.

References

Chesla, C. A., Fisher, L., Mullan, J. T., Skaff, M. M., Gardiner, P., Chun, K., et al. (2004). Family and Disease Management in African-American Patients With Type 2 Diabetes. Diabetes Care, 27(1), 2850-2855.

Hannon, T. S., Gutham, R., & Arslanian, S. A. (2005). Childhood Obesity and Type 2 Diabetes Mellitus. Pediatrics, 473-480.

Nathan, B. M. (2007). The Increase of Type 2 Diabetes Mellitus in Children. Retrieved from Minnesota Medicine: http://www.minnesotamedicine.com/PastIssues/PastIssues2007/November2007/ClinicalNathanNovember2007.aspx

NDIC. (2011). National Diabetes Statistics, 2011. Retrieved from National Diabetes Information Clearinghouse: http://diabetes.niddk.nih.gov/dm/pubs/statistics/#fast

Rosenbloom, A. L. (2002). Increasing Incidence of Type 2 Diabetes in Children and Adolescents. Pediatric Drugs, 4(4), 209-221.

Solowiejczyk, J. (2004). The Family Approach to Diabetes Management: Theory Into Practice Toward the Development of a New Paradigm. Diabetes Spectrum, 17, 31-36.

Diabetes, Type 2 In-Depth Report. (2008). The New York Times. Retrieved December 23, 2012, from http://health.nytimes.com/health/guides/disease/type-2-diabetes/print.html

Media Centre. (2012, September). Diabetes. Retrieved December 23, 2012, from World Health Organization: http://www.who.int/mediacentre/factsheets/fs312/en/