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VOLUME 11 NUMBER 3 • SEPTEMBER 2014
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
for supporting adolescents with diabetes through information and
behavioural reinforcement.
19
The potential of such interventions
in resource- and technology-constrained contexts has not been
investigated, given that access and availability of communication
technology is not equitable across all contexts.
With much research on adolescent diabetes coming from the
developed world, less research has been done around the specific
challenges of adolescents with diabetes in developing world contexts.
Unique research from Ghana has revealed significant structural
barriers facing adolescents with diabetes in this resource-constrained
context. These included misdiagnosis or late diagnosis at primary-
care level, stigmatising and unsupportive school environments,
affordability and accessibility constraints, lack of diabetes-specific
support systems and lack of accessible diabetes information.
20
Again, from local research, common challenges identified by
both caregivers and patients were negative emotional experiences,
sustaining motivation for health compliance, and the physiological
changes in adolescence. Caregivers included emotional challenges
affecting the caregiver and practical issues of supervision,
whereas the child/adolescent patients listed peer relations, school
environments and family environments as significant psychosocial
challenges in diabetes management.
2
Along with the physiological changes of puberty, adolescents
encounter a range of interpersonal adjustments and issues
of sexuality within cultural and social contexts. These include
negotiating love and friendships, variations in sexual activity, sexual
preference and risks of unplanned pregnancy. Few studies have
been done on sexuality and sex education for adolescents with
diabetes, yet this is a crucial domain of adolescent development, as
seen in recent research from Cuba.
21
Defining diabetes outcomes is a difficult task, as objective
measures of metabolic control may tell only some of the story.
Researchers on youth diabetes outcomes have defined diabetes
outcomes as a multifaceted concept that can include measures of
psychological well-being, mastery of developmental tasks, optimal
metabolic control, and active participation in diabetes care. With
this in mind, key interventional strategies should also include early
detection and intervention for psychological distress, and support for
transition from paediatric to adult care systems, a central challenge
in late adolescence.
22
Local research has suggested that optimal
outcomes may be achieved by supporting caregiver and adolescent
self-efficacy, a consistent and cohesive multidisciplinary treatment
team with patient-centered collaboration, supporting caregiver and
family functioning, supporting patient motivation, and appropriate
facilitation of health information to enhance health literacy.
2
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