In treating adolescents with Type I Diabetes Mellitus who are non-compliant with treatment, it is important to address both the medical aspects of management (blood sugar checks, insulin administration, carbohydrate counting) and the underlying social and psychological issues leading to noncompliance. Interventions that focus on emotional, social and family processes have shown good effects on Hb A1c control
We reviewed the multidisciplinary approach used to evaluate children with poorly controlled type 1 diabetes mellitus in an outpatient clinic setting. Patients and families were offered a variety of services depending on the needs and risk factors identified during the outpatient clinic visit; these included personal/group psychological therapy, social work evaluation and in rare cases, child protective service referrals.
We identified 46 patients with Type I Diabetes Mellitus who were at least 10 years old with a HbA1c at 10% or above. Twenty five percent of them received psychology/psychiatry evaluation, 70% received social work evaluation to address social stressors and family conflicts while 5% were referred to child protective service
Exploring the psychological and social factors in pediatric diabetes is an essential step in improving adherence to optimal management and better disease outcome.