Medicine Matters diabetes

I think one of the big challenges in pediatric diabetes, especially in pediatric type 1 diabetes, is the psychosocial burden and challenges that children and adolescents, as well as their families, face with the extreme burden of care that type 1 diabetes imposes on a child and on the family as well. It's very demanding to take care of type 1 diabetes. It's not something that a child or their family can take a break from on a day. You have to continue to care for it. It's relentless, and attending to the psychological needs of children, and their parents, and family are very, very important.

When you think about all that people with type 1 diabetes have to do to care for their diabetes, it's daunting. If you're using blood-glucose monitoring, people will be checking finger pokes six to 10 times a day, or more. Whether you're on injections, or insulin pens, or if you're on an insulin pump, you're going to be giving a dose of insulin every time you eat, as well as figuring out what your basal needs are of insulin.

In addition to this, then there's challenges with how to manage exercise how to keep your glucoses in control. And often people are very worried about low glucoses, and also, at the same time, then, the long-term effects of elevated glucoses and the potential for vascular complications in the future. So there's quite a bit that people with diabetes and their families have to do, and as a clinician, it's extremely important that we address these concerns and worries that families have.

So I think along the lines of research, it's really important-- some of the work that's been done just around diabetes technology. Why is it that some people aren't using some of these systems which have been shown to have better outcomes? So I think some of the psychological concerns around diabetes technology are going to be important points going forward, to make these systems more user friendly, to make them not only help us achieve better glucose control, but also, to reduce the burden of care on people with diabetes, and their families, and to lead to better quality of life, which I think is extremely important.

I think another really important area is screening for depression, and that is something that should be widespread. And it allows the ability to identify depression early so that it can get treated and taken care of.

So as far as the importance of psychological care in diabetes, it's extremely important and should be a part of every child and adolescent's diabetes care. And I'm very thankful that we have a strong diabetes psychology team here at Stanford.