The University Hospital of Wales’ Diabetes Team provides young people (YP) up to the age of 25 with Type 1 diabetes (T1D), and their families, with education and support to manage diabetes. A youth worker (YW) works across paediatric and adult diabetes services that care for approximately 300 children and YP across Cardiff and Vale University Health Board. Physical and emotional self-care are essential to reduce short and long-term complications and risks of T1D such as retinopathy, heart and kidney problems. Managing a chronic condition can negatively affect emotional wellbeing, which reduces motivation to manage the condition. YW consultations with the YP suggested they would like to: focus on mind and body; meet an inspirational role model living with T1D, and participate in sport and peer support. The result was a Futsal day (a form of indoor football) organised for 25 YP with T1D aged 10-14 and 16-25. The morning was facilitated by Chris Bright, founder of The Diabetes Football Community (TDFC), and the afternoon focused on peer support. There were Futsal activities, skills and tournaments in the morning, a group lunch that focused on carb counting and then a tour of Cardiff City Stadium in the afternoon. The day aimed to raise awareness of: how the mind and body interlink; the benefits of physical exercise; how to manage when T1D feels overwhelming; not being held back from achieving by T1D, and why it is important to manage T1D effectively to minimise long-term complications and feel better in the short-term.
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YP with T1D endure a lifetime of monotonous and rigorous health care management, often resulting in psychological maladjustment. There is a strong correlation between poor diabetes management and depressive symptoms, suggesting a relationship between T1D and mental ill health. Physical activity for people living with T1D is associated with well-established health benefits, including improved cardiovascular fitness, better bone health and enhanced psychological wellbeing. This promoted a novel approach to help YP with T1D to explore the benefits of exercise on their mental wellbeing. Following a consultation with YP with T1D, the YW discovered Futsal, which is a bit like five-a-side football. Emphasis is on improvisation, creativity and technique so does not intimidate those who are new to sport or football. Seven 16-25-year-olds with T1D, who are patients at the University Hospital of Wales, took part. The pilot was organised with TDFC, a not-for-profit organisation set up by Bright in 2017 as a network for sharing experiences of diabetes and football. Bright has had T1D since 1999 and has played football for his county, university and as a semi-professional. Subsequently a second day was run with 10-14-year-olds. This is the first health board in the UK to design, deliver and partner with TDFC to provide such a day. The YP’s physical, mental and emotional health were considered alongside the social factors and a major aim was to provide peer support, which has benefits in managing diabetes.
A total of 60 YP aged 16-25 were invited by post and via posters of the event in clinic to attend the Futsalday.A total of 72 YP aged 10-14 were invited via post, posters in the waiting room, promotion by the MDT and Twitter.The initiative was implemented by Chris Bright and the YW but the YP were also consulted.They used the Cardiff City House of Sport Futsal court. They brought their own packed lunch and equipment/treatment they needed to manage their T1D. The aim of this was to encourage self-management of their diabetes, without parental supervision for some, but under the observation of a diabetes nurse. The organisers brought supplies as well. Chris Bright attended for the whole day so the YP were able to ask him questions throughout. Blood glucose level testing was included as a fun peer activity, to show how exercise can affect levels. This helped to reduce the isolation children feel when testing around peers without T1D. Bright led by example with regular testing, showing that diabetes is easier to manage when testing often.
This day was designed to enhance the wellbeing of YP living with T1D through peer support. It included engagement in a new sport, meeting a professional Futsal player who lives with T1D and being able to mix in a non-confrontational environment with others. The hope was that they would engage more with their T1D. Outcomes achieved by the ‘futsal day approach’: YP said they felt less isolated; they increased their peer support network; they explored the benefits of a healthy mind and body and the positive effects exercise can have on them and their diabetes management in the short and long term; spending time with their diabetes clinic team in a different environment helped to build strong relationships to improve the clinical relationship; they strengthened their engagement with their T1D through seeing positive opportunities from having it. The YP engaged well with each other and staff. They all managed their own hypos, increasing their ability to manage T1D independently. Bright’s talk demonstrated an understanding of the issues that the YP do not often get. Parents of the younger group shared how they enjoyed the break, feeling reassured that their YP were in safe hands. The feedback provided a 100% recommendation for the Futsal days.
Sustainability and Spread
This Futsal day is replicable by other teams with the support/package provided by Bright and TDFC.
The initiative can be spread to other geographical areas/used with other health-based teams. Each day was funded by money fundraised by the YP. As the YP see their fundraising being used for activities that benefit them, this motivates them to keep fundraising, which in turn raises awareness of T1D and benefits their relationship with the condition. This also increases their engagement with their diabetes team, reducing the risk of disengagement in their adolescent years.
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