Washington: Turns out, people with type 1 diabetes are far more likely to develop cardiovascular disease than those without it. The risk is even higher if they show signs of hypertension, high blood pressure, unhealthy levels of cholesterol and dyslipidemia. This study highlights strategies to help young people manage high cholesterol and blood pressure.
Interviewing teens and parents, Joslin Diabetes Center researchers have identified strategies to help teens with these conditions manage them better. The study was recently published in the Journal of Pediatric Diabetes.
Offering realistic and specific guidance begins with delivering basic knowledge about the conditions, says Katz, who is also an assistant professor of pediatrics at Harvard Medical School. Asked about the risks of high blood pressure, for instance, teens might say that it could give you a headache, rather than realizing it might lead to a heart attack many years from now. Teens also often hoped that the condition might be “fixed” rather than needing to be continually managed.
“There’s immediacy in how teens view things. So we try to reach them where they’re at, and think about what will motivate them. For example, a lot of heart-healthy behaviors may improve how they look and feel. Some teens may be motivated by the prospect of losing weight, or having more energy, or potentially having clearer skin,” said study author Michelle Katz.
Katz further added, “Teens also look for detailed personalized guidance. They want to know, ‘What is my personal risk? What are my risk factors and what can I do about them? What are the foods that I can eat, what’s a good menu for me, and what are good activities for me?”
Exercise is just as crucial for heart health for teens as it is for adults. “What makes this easier is being on a sports team, having some sort of regularly scheduled exercise, or having a friend to go to the gym with,” said Katz.
“You always encourage teens to do the types of activity they like. Sometimes you have to get down into the details with them to coax them along: Do you enjoy playing basketball, do you have another friend who enjoys playing basketball, do you have a playground in your neighborhood or can you go to the local?” added Katz.
Based on semi-structured interviews with 22 teens who had type 1 diabetes (45% with dyslipidemia) and 25 parents (40% who had teens with dyslipidemia), the study highlighted issues that were viewed quite differently by teens and their parents.
Teen and parent perceptions varied, for example, about when to start heart protective medicines if and when they were recommended by a physician.
Some parents were worried about side effects. Some parents were worried that these medications are lifelong therapies and they are for conditions associated with older people. Teens, in contrast, were more likely to see the medicines as simply one more addition to their daily regimen of medications.
Teens also were more likely than parents to suggest that their own homes weren’t the healthiest environments for food. As parents typically buy the groceries and do the cooking, making better choices calls for a team effort, Katz noted.
The team is now running a pilot study to encourage heart-healthy behaviors in teens with type 1 diabetes and additional cardiovascular risk factors, using lessons learned from the study.