Barriers and Resources to Managing Type 2 Diabetes and Transitioning to Adult Care Among African American Adolescents

Background and Purpose: Type 2 diabetes mellitus (T2DM) in adolescents is increasing in pediatric clinics across the U.S., particularly among minority youths. Because these youths are likely to be obese, and from families with few resources, lower incomes, and single parents, achieving good disease control has been difficult. Problems with self-management have contributed to disparities in health between African Americans and other populations. Currently, very little is known about the psychosocial factors related to diabetes management in this population (i.e., fewer than 5 studies), and even less about preparing older adolescents for young adulthood. To address this, a qualitative study was conducted to answer two questions: 1) what are the barriers and resources to positive self-management among African American adolescents with T2DM? 2) What are their perceived diabetes-related needs as they transition to adult care? Methods: In-depth semi-structured interviews were conducted with 10 African American adolescents with T2DM who receive care at a pediatric clinic, and their 10 mothers. One-hour interviews were conducted separately focusing on perceptions of: psychosocial and contextual (school, family, economic) barriers and resources to self-management; and plans for the adolescents' future as they move to young adulthood. The analysis followed a grounded theory approach. Interview transcripts were managed and coded in NVivo 7. Coding schemes and interview excerpts were compared among team members for accuracy and reliability. Thematic analysis of coding reports from adolescents and their mothers were conducted separately through consensus. Mothers' ages were 35-46 years old (mean 41.7 years). 6 were employed, 3 had greater than high school education, and 4 had T2DM. Youths' ages were 14-19 (mean 16.4 years), and their insurance status was: 7 Medicaid, 1 private, and 2 with no insurance. Results: Mothers identified several themes that posed barriers to self-management: comorbidities (i.e., asthma, obesity, learning disabilities), difficulties implementing diet and exercise, and teenage/peer issues. Resources included: support from family members with T2DM, family folklore used to motivate youth, Medicaid coverage, responsive providers, and a belief in the severity of T2DM. Among mothers of both younger and older adolescents, almost half had not given any thought to their child's needs for transitioning. Adolescents echoed similar themes as mothers, but also expressed fear of complications (i.e., blindness) based on information from family members and providers. Youths also reported experiencing daily stress related to dietary restrictions, blood glucose monitoring, and taking medications. Conclusions and Implications: Adolescent issues that pose challenges to diabetes management (i.e., diet, exercise, peers) are complicated by comorbidities. Despite the lower socioeconomic status of these families, access to treatment and medications is less of a problem due to Medicaid. However, very few mothers are thinking about coverage for when the child is too old to be eligible, and both mothers and youths are not addressing the psychosocial needs such as stress and disease-related anxiety of their child at present, or for young adulthood. Knowledge from this study will inform future quantitative research, and development of behavioral strategies to improve management of T2DM and reduce health disparities in African Americans.