Psychological issues

During a meeting halfway through a 24-month project for the UK National Institute for Health and Clinical Excellence (NICE), surrounded by well-known health professionals, Barbara Elster was asked her opinion on one of the subjects under discussion. Having expressed her views, she contemplated how she, a person with no formal medical training, had come to be in such esteemed medical company, involved in producing national guidelines on diabetes for the UK Government.

Adolescence, the period of transition from childhood to adulthood, is a key phase of human development. It is characterized by rapid changes – physical, sexual, psychological, emotional, cognitive, and social. The psychological imbalance that prevails during adolescence is particularly significant in people with diabetes as it often leads to a decline in self-care. This brings about a deterioration in blood glucose control, and creates difficulties that hamper the development of harmonious relationships between the young person with diabetes and his or her healthcare providers.

A culturally sensitive, intensive diabetes education service is being delivered in the community to people of ethnic-minority origin living with type 2 diabetes in Lothian, Scotland. Designed by a pharmacist, the initiative began as a research project, but the effectiveness and popularity of the programme resulted in its development and implementation as part of the local diabetes care package.

The USA ranks third in the global prevalence of diabetes, preceded only by India and China. About 7% of the population has diabetes. A third of the total number of people with the condition is believed to be undiagnosed and therefore not receiving treatment to reduce the risk of disabling and life-threatening diabetes complications. The economic costs of diabetes are enormous – estimated at 132 billion USD in 2002. The mission of the US National Diabetes Education Program (NDEP) is to reduce diabetes-related illness and death.

The objective of holiday camps for children and adolescents with diabetes is to create an environment in which they can learn to embrace their condition and its treatment. Achieving and maintaining good blood glucose control is a key aim; the camps provide excellent opportunities for young people to learn and practise diabetes skills and become familiar with the latest techniques.

Diabetes is a family affair. When a child is diagnosed with diabetes, a wide range of challenges affects parents and siblings. While the role of parents in day-to-day living with diabetes is subject to constant change according to the age of their child, it is always crucial. Families constantly experience their loved-one’s diabetes, in an emotional as well as a practical sense. Eveline van Gulik explores some of the challenges faced by parents of children with diabetes, and describes, from her own experience, the enormous impact on family life.

Average temperatures are rising due primarily to the release of increased amounts of carbon dioxide and other greenhouse gases through the burning of fossil fuels. This is provoking other changes, including rising sea levels and changes in rainfall. These changes appear to be increasing the frequency and intensity of extreme weather events – floods, droughts, heat waves, hurricanes, and tornados – which have the potential to provoke large-scale human crises.

In many countries, young people work effectively as advocates for a range of causes, from inner-city regeneration to anti-bullying and smoking cessation. An IDF initiative aimed to engage Youth Ambassadors in diabetes advocacy worldwide and specifically to participate at as many levels as possible in IDF’s global awareness campaign ’Unite For Diabetes’. In this article, representatives from the group describe the principles and objectives of the IDF Youth Ambassadors programme and make a call for increased involvement of young people in diabetes advocacy.

Diabetes has become a global health problem, reaching epidemic proportions worldwide with serious implications for health and well-being. The International Diabetes Federation estimates that by 2025, almost 350 million people will have diabetes. People who are most vulnerable to this chronic disease include those living in developing countries, and members of minority ethnic groups and socio-economically disadvantaged people in developed countries.

People with diabetes deliver most of their own care. This reflects the observation that diabetes and its associated features touch on most aspects of daily living, and aspects as fundamental as eating and physical activity. To deliver such care requires knowledge, but even with knowledge it may not be easy to adjust to optimal self-care. This makes patient education a complex therapeutic issue.