Students with Diabetes: A Tool Kit for Supporting Health and WellnessAMERICAN COLLEGE HEALTH ASSOCIATION

2017 ANNUAL MEETING

PresentersSara Lee, MD

-University Health & Counseling Services, Case Western Reserve University

Jennifer Saylor, PhD-Assistant Professor, School of Nursing University of Delaware

Charles Riley-Program Assistant, The College Diabetes Network

Learning Objectives•Understand the health and wellness needs of young adults with diabetes

•Understand the challenges to independence of care for young adults with diabetes

•Understand the tools available to improve the wellbeing of students with diabetes on campus

Classification of Diabetes• Type 1 Diabetes• Beta cell destruction

• Type 2 Diabetes• Progressive insulin secretory defect

• Gestational Diabetes Mellitus (GDM)

• Other specific types of diabetes• Monogenic diabetes symptoms

• Diseases of the exocrine pancreas (e.g. cystic fibrosis)

• Drug or chemical induced diabetes

American Diabetes Association Standards of Medical Care in DiabetesClassification and Diagnosis of Diabetes, Diabetes Care 2017, 40 (Suppl. 1) S11:S24

Common Comorbidities• Autoimmune diseases (T1D)

• Cancer

• Cognitive Impairment Dementia

• Fatty Liver Disease

• Fractures

• Hearing Impairment

• HIV

• Low Testosterone (Men)

• Obstructive Sleep Apnea

• Periodontal Disease

• Psychosocial Disorders

American Diabetes Association Standards of Medical Care in DiabetesComprehensive Medical Evaluation and Assessment of Comorbidities, Diabetes Care 2017, 40 (Suppl. 1) S25:S32

Diabetes Management SkillsProvide own medical historyDiscuss role of insulin in bodyAdjust insulin levels for carb intake and BG levelsDiscuss what HbA1c level meansTalk about goal BG and HbA1c levelsAssess psychosocial comorbiditiesExplain how exercise affects BG levelsKnow when it is not safe to drive, how long to wait after lowExplain effect of alcohol on bodyExplain possible long term complications of T1DExplain sick day management planOrder insulin, test strips, and ketone stripsMake doctors appointmentsIdentify insurance plan and what is coveredKeep track of insurance claims

Walker, K.A. 2013

Contributing Factors

LIFE-No routine/unpredictable schedules, late nights-Stress-Alcohol and drugs-No stable support system, new friends-Social pressures-Wanting to be normal-Limited food options-Desire for spontaneity-Financial concerns-Forming identity-Priorities evolve throughout college years

DIABETES-Transition of care-Transition to independent management-Increased responsibility-Less parental involvement-Registration with “Disabilities Services”-Responsibility for informing professors-No support resources or education typically available on campus

Diabetes in College: The perfect storm of young adulthood

-At any given time, there are an estimated 53,000 college students with Type 1 diabetes in the United States

-71% of college students report having difficulty managing their diabetes while at school

Problem: Accessibility issues and accommodations•Academics

• Highs/lows and cognitive function

• Exams and tests

• Classroom accommodations (diabetes tech, food and drink, etc.)

•Dining• Limited healthy food options

• Lack of, or inaccurate, nutritional info

•Athletics• Highs/lows at practice/events

Workplace• Workplace accommodations

• Discrimination

Housing◦ Accessibility (refrigerator, AC, close to dining hall, etc.)

◦ Roommate issues

Mental Health Concerns-Young adults with diabetes are at an increased risk of developing depression, anxiety, and eating disorders compared to their peers*

◦ Of 150 teens and young adults (ages 11 to 25 years) with type 1 diabetes…◦ 11% had depression,

◦ 21% had anxiety

◦ 20% had disordered eating

◦ Teens and young adults with mental health issues are twice as likely to have poor diabetes control, putting them at risk of a number of complications

*Soren, K., & Grey, M. (2015, April 27). Depression, Anxiety, and Eating Disorders Are Common in Teens and Young Adults with Type 1 Diabetes. Retrieved April 7, 2017, from https://www.endocrineweb.com/news/diabetes/14504-depression-anxiety-eating-disorders-are-common-teens-young-adults-type-1-diabete

Diabetes DistressDiabetes distress

◦ Very common and distinct from other psychological disorders

◦ Negative psychological reactions related to emotional burdens of managing a demanding chronic disease

American Diabetes Association Standards of Medical Care in DiabetesLifestyle Management, Diabetes Care 2017, 40 (Suppl. 1) S33:S43

TransitionTransition is a process• “The planned, purposeful movement of young adults

from child-centered to adult-oriented health-care systems”

• Ideally has begun in middle school*

For young adults with diabetes: Delays in care

Increased diabetes-related hospitalizations

General dissatisfaction

Transition ChecklistProvide own medical historyDiscuss role of insulin in bodyAdjust insulin levels for carb intake and BG levelsDiscuss what HbA1c level meansTalk about goal BG and HbA1c levelsAssess psychosocial comorbiditiesExplain how exercise affects BG levelsKnow when it is not safe to drive, how long to wait after lowExplain effect of alcohol on bodyExplain possible long term complications of T1DExplain sick day management planOrder insulin, test strips, and ketone stripsMake doctors appointmentsIdentify insurance plan and what is coveredKeep track of insurance claims

Walker, K.A. 2013

CDN Survey Results•Student experiences on campus survey

•Administered April 2017

•375 participants• 129 Non-CDN Chapter Members

• 246 CDN Chapter Members

Chapter members vs. Non-members: Levels of isolation with diabetes

2%

19%

53%

20%

6%

Since starting college, I feel my level of isolation with diabetes has...

Decreased significantly Decreased Not changed/stayed the same

Increased Increased significantly

24%

49%

22%

4%

1%

Since joining my CDN Chapter, I feel my level of isolation with diabetes has…

Decreased significantly Decreased Not changed/stayed the same

Increased Increased significantly

Chapter members vs. Non-members: Number of low blood sugar events experienced

1%

12%

81%

5%

1%

Since joining my CDN Chapter, the number of low blood sugar events (hypoglycemia) I experience has...

Decreased significantly Decreased Not changed/stayed the same

Increased Increased significantly

2%

15%

41%

41%

1%

Since starting college, the number of low blood sugar events (hypoglycemia) I experience has...

Decreased significantly Decreased Not changed/stayed the same

Increased Increased significantly

Chapter members vs. Non-members: A1c

3%

33%

21%

43%

Since starting college, my A1c has...

I'm not sure - I haven't gotten my A1c since I started college Lowered Not changed Risen

7%

31%

54%

8%

Since joining my CDN Chapter, my A1c has...

I'm not sure - I haven't gotten my A1c since I started college Lowered Not changed Risen

Students who indicated they suffer from or have suffered from depression

47%

5%

48%

Since joining my CDN Chapter, my depression has...

Gotten better Gotten worse Stayed the same

31%

57%

12%

Since starting college, my depression has...

Gotten better Gotten worse Stayed the same

n=35n=77

Student PerspectiveDiabetes in College• Can be difficult without planning

• New limitations

• Undue stress

• Advocacy burnout

• Can be isolating• Internalization

• Shame

• Self-dependence

• Can be confusing• Technology usage

• Emergency situations

• New experiences

• Can be frustrating• Campus knowledge base

• Campus policy

Solution: CDN Suite of ResourcesOff to College ProgramOff to College Booklets for Students Off to College Booklets ParentsOff to College Event

Campus ToolkitsDisability Services ToolkitCounseling Center ToolkitHealth Center Health Toolkit

Solution: Off to College Program Program provides resources for…

High school students with diabetes

Parents

Health care providers

Topics Covered Looking at schools, packing, finding a new clinician,

parent/child communication, expected campus challenges, talking to roommates, alcohol, and more.

Audience specific versions – Student and Parent

Solution: Campus Toolkits Program DevelopmentNational and multi-professional representation College Administrators

Disability administrators

Faculty

Legal representation

Nurses

Parents with type 1 diabetes who attend college

Pharmacists

Physicians

Students with type 1 diabetes

Solution: Toolkit CommonalitiesGeneral Clinical InfoWhat is Type 1 vs. Type 2

How are they treated

What are the goals/risks

What is it like to live with a chronic illness

Awareness/educational poster seriesPowerPoint and print formats

Case Studies specific to each toolkit

Solution: Disability Services ToolkitsTopics/ContentsPotential accommodations for college students with diabetes, and the reasons

they’re important

Tips for interviewing students for accommodations requests

Template letters for…

Clinicians to approve accommodations

Professors regarding accommodations

Solution: Disability Services Toolkits cont. Topic/Contents

Innovative methods for marketing services

Provided by disability services to various student populations on campus

Pictures of diabetes technology and explanations

Informational resources about diabetes impact on a students’ college experience

Case studies from schools that are utilizing innovative and successful methods for serving students with diabetes

Solution: Counseling Center ToolkitTopics/Contents Mental Health Conditions to be aware of Depression, anxiety, eating disorders, ADHD How a young adult with diabetes may present (particularly for eating disorders) How they may interact with diabetes How to differentiate between depression and burnout

Do's and Don'ts of providing mental health services to a young adult with diabetesGlossary of Terms: language their patient might use

Case StudiesResources to Learn More

Solution: Health Centers ToolkitTopics/ContentsDiabetes impact on a students college experiencePictures of diabetes technology and therapies with explanations

Mental health conditions to be aware of and how they may present in a young adult with diabetes

Template letter for clinicians to approve accommodations

Case study – Stanford Vaden Health Center

APPLICATION:HOW YOU CAN USE THESE MATERIALS ON YOUR CAMPUS

Distribute digital versions of CDN Off to College Booklets to incoming freshman with diabetes prior to their arrival on campus

Order hard copies of the Off to College booklets and make available in health center, counseling center, and disability services

waiting rooms and exam rooms

Sign up for the CDN Campus Toolkit waiting list to receive quarterly updates on the pilot year, and be first in line to get your

free kit in 2018!

www.collegediabetesnetwork.org

Students with Other Chronic Illnesses20% of US youth have a chronic medical condition or special health care need

Transition is always important – transition to college is often left out of health care transition transition.gov

Few colleges have systems to identify and track students with chronic illnesses

Support groups

Use elements of the toolkit

What’s Next?• After the pilot year of the Campus Toolkits in 2017-18, the Campus Toolkits will be available nationally

for the 2018-2019 school year• The CDN Campus Advisory Committee will be reviewing pilot program data in early 2018 to make revisions for the national launch.

• Pre, mid, and post evaluations will be conducted with pilot schools

• All pilot schools must have all three departments on board to participate

• Other resources launching in 2017• “Off to Work Guide” for young adults with disabilities entering the workforce

• Newly diagnosed young adult resources (for those diagnosed with type 1 diabetes between the ages of 17-25)

• Mental health webinar for young adults and clinicians

• Continued growth of CDN Chapter Network for peer-to-peer connections of young adults with and affected by diabetes on college campuses

How to order Off to College MaterialsYou can request free hardcopy or digital Student and/or Parent “Off to College booklets” and the “Off to College Event Host Guide” using this form:

tiny.cc/CDNmaterials

How To Get a ToolkitStep 1:

Before leaving this session, enter your name, email, and institution on our sign-up sheet to be contacted after ACHA about participation in the pilot program or other CDN materials.

Step 2:

CDN will reach out to you with an application for the Campus Toolkit Pilot Program. You will be notified if you are selected for the pilot program by July 15th.

Thank you!•To attendees of this presentation

•To those that made the development of these Campus Toolkits possible• CDN Campus Advisory Committee

• CDN Students

Stay Connected!FACEBOOK

facebook.com/thecollegediabetesnetwork

TWITTER@CollegeDiabetes

INSTAGRAM@CollegeDiabetes

EMAIL info@collegediabetesnetwork.org