1

Luke Shealy
November 10, 2014
Section 3
Instructor: Wendy Bianchini Morrison
Title:
Children Diagnosed with Type 2 Diabetes and its Impact on Human
Development through Urie Bronfenbrenners Ecological Theory of
Development

Inquiry Topic & Bronfenbrenners Model

It used to be called adult-onset diabetes, but today, type 2 diabetes
mellitus (T2DM) is one of the fastest growing epidemics affecting childrens
health in the United States. It is reaching alarming proportions, and causes
lifelong health complications including premature heart disease, stroke,
blindness,

kidney

disease,

and

amputation

(Kupecz,

2001,

p.1)

Unfortunately, these complications are being seen at earlier and earlier ages
(Kupecz, 2001, p.1). T2DM starts as insulin resistance in the body. Red blood
cells are unable to take in sugar, and the increased sugar in the blood stream
damages the body and the bodys organs (Smith, personal communication,
2014). It is a preventable disease. Several of the risk factors associated with
type 2 diabetes include: obesity, sedentary lifestyle, older age, family history
of diabetes, history of gestational diabetes, and race or ethnicity (Smith,
personal communication, 2014). By the year 2050, one third of the U.S.
population will be diagnosed with T2DM, including children (David and
Couric, motion picture, 2014). Children born in the last 15 years will be the
first children in U.S. history to live shorter lives than their parents (David and
Couric, motion picture, 2014). The effects of children diagnosed with T2DM
on

human

development

will

be

profound

and

far-reaching.

Urie

Bronfenbrenners Microsystem is one of the most significant areas affected in

Bronfenbrenners ecological framework for human development. Due to the
immediate impact on the child, the childs family life, and school life, being
diagnosed with T2DM impacts the childs immediate relationships. The

childs social, physical, and emotional development is oftentimes negatively

impacted.

Inquiry
Emma Wilmot and Iskander Idris discuss the toll of T2DM diagnoses
and management on children and adolescents in their article, Early onset
type 2 diabetes: risk factors, clinical impact and management. As T2DM
becomes the predominant form of diabetes, we are going to see children
and young adults develop microvascular and macrovascular complications,
in addition to psychological morbidity, during their working life, (Wilmot and
Idris, 2014, p.1). These complications include: kidney disease, heart disease,
limb amputation, blindness, fatty liver disease and ultimately a life
expectancy shortened significantly (Wilmot and Idris, 2014, p.3-8). On top of
the physical impacts, psychologically, children and adolescents are prone to
several psychological impacts that adversely affect their social lives and
emotional well-being. These impacts include: body dissatisfaction, binge
eating disorders, impaired general emotional well-being, and lower quality of
life, (Wilmot and Idris, 2014, p.8).
According to the authors of the article Adolescents and type 2
diabetes mellitus: a qualitative analysis of the experience of social support,
children and adolescents with T2DM have a fear of disclosure and will

typically limit who they tell to their close friends and family, (Brouwer,
Salamon, et al, 2012, p.1). Because of the shame associated with the
disease, and the popular belief that T2DM is due to being lazy and obese,
many children keep their diagnoses as secret as possible and fail to engage
in support groups or other positive outlets (Smith, personal communication,
2014). Most of the children and adolescents diagnosed with T2DM are from
lower socio-economic statuses and tend to be minority ethnic groups
(Anacker, personal communication, 2014). It is already difficult for these
children to fit in and find a sense of belonging. Being diagnosed with T2DM
further stigmatizes them and alienates them (Shealy, personal
communication, 2014). Often-times children are placed on Individualized
Education Plans (IEDs) and have to be closely monitored due to health
concerns (Anacker, personal communication, 2014). This can further drive
home a feeling of not belonging and alienation within the school
environment. It affects childrens ability to make friends and establish social
attachments at a time when forming friendships with peers is
developmentally essential in their push for autonomy (Belsky, 2013, p.286).
Another significant impact being diagnosed with T2DM has on children
has to do with self-esteem and attachment to family members. Childrens
self-esteem begins to become a major issue during elementary school,
(Belsky, 2013, p.175). When children are diagnosed with T2DM, they typically
suffer from lower self-esteem and more insecure parental attachments
(Smith, personal communication, 2014). An important aspect to remember

is to not shame children or their families when intervening and working with
them. It must be a family centered approach instead of alienating or isolating
the child to the point where they feel punished or targeted, (Anacker,
personal communication, 2014). For example, parents will tell their child
diagnosed with T2DM they cannot eat sweets or drink soda, and they must
exercise for an hour a day, while they allow the other children in the home or
themselves to eat sweets and play video games in perpetuity (Smith,
personal communication, 2014). This mentality of singling out a child and
potentially shaming a child is both an unsuccessful intervention and
detrimental to a childs self-esteem and family attachments.

Cultural Comparison
In the United States the number of children being diagnosed with
T2DM is increasing steadily. It is currently estimated that 8% to 45% of all
children with recent diabetes diagnosis have T2DM (Kupecz, 2001, p.2).
Unfortunately, there is a large discrepancy between cultures and ethnicities
with the diagnosis. The ethnicities in the United States who are hardest hit
by this disease include Native Americans, African Americans, Hispanics, and
Asian/Pacific Islanders (Kupecz, 2001, p.1).
As early as 1979 the first case of T2DM being diagnosed in a child was
reported in a Prima Native American teenager in Arizona (Kupecz, 2001, p.1).
Between 1988 and 1996, the Indian Health Service documented a 54%

increase in prevalence of reported T2DM cases in 15 to 19 year olds (Kupecz,

2001). Because there is no cure for this disease, it is a life altering and
lifelong diagnosis (Schreiner, 2014, p.5). It increases the likelihood that
children may develop serious long-term complications such as blindness,
kidney disease, and heart disease. If it goes untreated, circulatory problems
may develop that are severe enough to require the amputation of limbs
(Woolston, 2014, p.1). Native American populations in the United States are
already on the decline. T2DM represents a further existential threat. It will
require the efforts of the government, the community, families, and the
individual to manage and prevent this disease from continuing to pose such
a severe threat to Native Americans.
In Australia, indigenous populations face a similar existential threat
from children being diagnosed with T2DM. As in the United States, the
indigenous populations of Australia are disproportionately diagnosed and
affected by this epidemic (Erickson, Whiting, 2013). 53% of the children
living with T2DM are indigenous, and their median age is 13.6 years old.
Many of them live in rural areas. The management of T2DM in indigenous
Australian children represents many of the same challenges as managing the
disease amongst American children and especially Native American children.
Much like Native American children, the indigenous populations of Australia
typically live in rural areas and are of lower socio-economic status with less
access to resources, including medical resources (Davis, Maple-Brown, 2010
p.1). Another common contributing factor to the difficulty of living with and

managing the lifelong disease is poor access to affordable and healthy food.
Diet and lifestyle changes are paramount and education around these
issues needs to be done in an appropriate cultural context (Davis, MapleBrown, 2010, p.1). Unfortunately for both the Native American population,
and the indigenous populations of Australia, the infrastructure for these
necessary interventions does not currently exist. Children and families are
left to deal with T2DM diagnoses without structured diabetes education,
and a significant number have impaired emotional well-being and physical
health, (Browne, et al, 2013, p.1).
Conclusion
Childhood and adolescence are already very difficult periods of human
development without being diagnosed with a lifelong and life altering disease
such as T2DM. Identities are being formed, independence is being exerted,
and attachments are being formed. T2DM makes it more difficult to engage
these developmental stages. Just as you are starting to find out who you are,
a new label is thrown in, and just as you are becoming more independent,
you find yourself more dependent on others. And when you are beginning to
make new friends and attachments, you find a part of yourself that you are
hesitant to share with others due to a fear of judgment and shame. Type 2
diabetes is going to become an ever-larger part of youths existence, and it
will continue to shape the most intimate forms of Bronfenbrenners
Microsystem of development. Healthier interventions and a better
understanding of the disease and its impacts on human development are
critical and necessary.

References
Allan, CL, Flett, B, Dean, HJ (2008). Quality of life in First Nation youth with
type 2 diabetes. Maternal Child Health Journal, Supplemental 1:103-9.
Doi: 10.1007/s10995-008-0365-x.
www.ncbi.nlm.nih.gov/pubmed/18500548
Anacker, M., (2014, October 13). Personal Communication, Bozeman, MT.
Anderson, B.J., McKay, S.V., (2009). Psychosocial issues in youth with type 2
diabetes mellitus. Current Diabetes Reports April 9 (2): 147-53.
www.ncbi.nlm.nih.gov/pubmed/19323960

Belsky, J. (2013). Experiencing the lifespan (3rd edition). New York City, NY:
Worth Publishing.
Brouwer, AM, Salamon, KS, Olson KA, Fox MM, Yelich-Koth, SL, Fleischman,
KM, Hains, AA, Davies, WH, Kichler, JC (2012). Adolescents and type 2
diabetes mellitus: a qualitative analysis of the experience of social
support. Clinical Pediatrics (Philadelphia Journal), 51 (12), 1130-9.doi:
10.1177/0009922812460914
www.ncbi.nlm.nih.gov/pubmed/23034947/
Browne, JL, Scibilia, R., Speight, J., (2013). The needs, concerns, and
characteristics of younger Australian adults with Type 2 diabetes.
Diabetic Medicine May 30 (5) 620-6. Doi: 10.1111/dme.12078.
www.ncbi.nlm.nih.gov/pubmed/23181664
David, L. and Couric, K. (Producers), & Soechtig, S. (Director). (2014). Fed Up
[Motion picture]. United States: Atlas Films
Kupecz, D. (2001). Drug news. Caring for children with type 2 diabetes.
Nurse Practitioner Dec 26 (12) 56-60.
http://eds.a.ebscohost.com.proxybz.lib.montana.edu/ehost/detail/detail
?sid=1bcdaf22-1c98-47e1-a3fa01efa0048534%40sessionmgr4001&vid=0&hid=4203&bdata=JnNpdG
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Maple-Brown, L.J., Sinha, A.K., Davis, E.A. (2010). Type 2 diabetes in
Indigenous Australian children and adolescents. Journal of Paediatrics

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and Child Health 46 (9) 487-490.

http://onlinelibrary.wiley.com.proxybz.lib.montana.edu/doi/10.1111/j.14
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Nsiah-Kumi, P.A., Lasley, S., Whiting, M., Brushbreaker, C., Erickson, J.M. Qiu,
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Schreiner, B. Be Healthy Today; Be Healthy For Life: Information for Youth and
their Families Living with Type 2 Diabetes. American Diabetes
Association 33page Pamphlet (retrieved online Nov 3, 2014.
http://main.diabetes.org/dorg/PDFs/Type-2-Diabetes-in-Youth/Type-2Diabetes-in-Youth.pdf
Shealy, S., (2014, November 9). Personal Communication, Bozeman, MT.
Smith, S., (2014, November 9). Personal Communication, Bozeman, MT.
Wilmot, Emma and Idris, Iskandar (2014). Early onset type 2 diabetes: risk
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