Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-33

• Marked change in body image. There may also be increased social responsibilities. This stage of life has been called the “Sandwich Generation” due to the responsibilities for care that middle-age adults assume, not only for their children (and sometimes grandchildren), but also for their parents. This age group usually has firmly entrenched health habits and, due to the complexity of their life, these habits are difficult to change. The goal for this stage of life is to: prevent complications, continue supportive relationships. This is also the stage of life when a new diagnosis of type 2 diabetes is frequently made. Increasing weight, lack of daily activity and additional life stressors are primary contributors to the development of type 2 diabetes in this age group. The 2018 Guidelines suggest screening for all individuals ≥40 years of age, earlier if at high risk (6 3). The fact that 20 to 50% of those diagnosed with diabetes already have microvascular or macrovascular complications suggests that we should be targeting this age group particularly for earlier diagnosis and treatment. The Diabetes Control and Complications trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), the Diabetes Prevention Program (DPP) and others have demonstrated that lifestyle changes with weight reduction, healthy eating and integrating exercise into the daily plan can have a significant impact on the rate of development of diabetes and of complications (64-67). However, implementing these changes in the middle-age adult is a formidable challenge (68). Suddenly, the person is forced to change health habits that have developed over many years. You can help by assisting the person to develop and implement a well thought-out, achievable plan. It is important to be sensitive to the fact that the middle years of life may be a stressful time, as people learn to cope with some of the following (62): • Teenage issues.

• Geographic distance from family of origin. • Children leaving home or not leaving home. • Children and/or parents being financially dependent. • Parents who are aging and losing independence. • Parents who may move in. • Careers that are “stuck” or that end suddenly.

• Diagnosis of a new health problem, along with pre-existing ones. • Changing self-concept that may accompany aging and illness. • Retirement.