I'm a nephrology nurse...I take care of people who wind up on dialysis. Yes, the vast majority are noncompliant. But when it comes to kids with type 1 diabetes, it's a whole different ballgame than an obese 65 year old with type 2. I have patients in their 30s who grew up with diabetes and no health insurance. Simple self care like checking your blood sugar is challenging when you can't afford to buy test strips. I've seen people ration their insulin and reuse needles scary numbers of times to try to save costs. If these people did things "by the book," they'd go through huge numbers of supplies, and it might be very expensive. Add to that limited literacy (health literacy and in general) and difficulties with obtaining food and transportation, and it's a recipe for disaster. Counting carbs is math, after all. It takes emotional maturity for anyone, never mind a teenager, to complete the exhausting self-care required to stay healthy. It's constant. There are so many socioeconomic factors at play...I feel it's really unfair to blame the patient or their parents. We truly don't know their situation.

That said...yes, absolutely, avoiding kidney failure is preferred to getting a transplant. However, a kidney/pancreas would literally cure his diabetes and keep him off dialysis. He may have 20 years before he needs new organs. Patients on dialysis have extremely limited life expectancy (50% of adults die within 5 years- peds stats are better, but I don't know by how much.) Dialysis is a life-sustaining measure, but it simply doesn't compare to a transplant. Of course, in order to qualify for a transplant, you'd want to address the same barriers I mentioned previously.