A Review of Adolescent Adherence in Type 1 Diabetes and the Untapped Potential of Diabetes Providers to Improve Outcomes

Abstract

Only 21 % of adolescents with type 1 diabetes (T1D) meet glycemic goals set forth by the American Diabetes Association. Adherence to therapy is a particular concern in this population, and the association between poor adherence and worsening glycemic control indicates that there is a critical need to improve adherence to therapy in adolescents with T1D. In this article, we review barriers to adherence in adolescents with T1D and discuss interventions aimed at improving adherence to therapy and glycemic control. Interventions include technology-based applications, family-based therapies, motivational interviewing, and others. Notably, less than 10 % of the interventions reviewed are provider-led, clinic-based interventions, and few have focused on regimen-related aspects of adherence. This article also outlines the importance of provider communication and the role of providers in facilitating adherence behaviors in adolescents with T1D. Finally, we suggest future directions of research to improve adherence to therapy in adolescents with T1D.

Adherence in adolescents with Type 1 diabetes: strategies and considerations for assessment in research and practice

“…The burden of adhering to these various behaviors is carried by adolescents and their families and affects nearly every aspect of daily life. Barriers to optimal treatment adherence are common and include competing demands for time and attention, miscommunication or misunderstandings about what to do (among family members and between families and healthcare providers), financial or insurance-related barriers to obtaining needed care/supplies, insufficient adult involvement or monitoring of adolescent self-management and emotional or behavioral difficulties, among others [7,13]. …”

“…For example, Datye and colleagues [13] offer suggestions on how diabetes care providers might explore common barriers to adherence. Additionally, a decline in adherence may indicate burnout or other psychosocial concerns, in which case a referral for behavioral intervention by a mental health professional may be helpful.…”

“…Additionally, multisystemic therapy and related approaches involve intensive intervention in all settings in which diabetes is managed (e.g., home, school, community settings); such approaches have demonstrated improvements in BGM, glycemic control and number of hospitalizations [70], and may also reduce healthcare costs [71]. In addition to these well-supported interventions, there are also several emerging adherence-promotion interventions that have preliminary support, including provider-delivered interventions such as motivational interviewing [13,72] and delivery of behavioral reminders and feedback via text messaging and other mHealth tools [73–75]. …”

New directions for diabetes prevention and management in behavioral medicine

“…Some populations, such as adolescents with type 1 diabetes, have numerous psychosocial barriers to adherence, making this an important area of concern (Datye et al, 2015). Intervention trials aimed at increasing adherence using a variety of approaches and points of contact such as peer coaching, telehealth, multidisciplinary providers and settings such as primary care, pharmacy and point-of-care testing have shown positive outcomes for both adult and pediatric populations (Capoccia et al, 2015; Hood et al, 2010).…”

Frequency of Missed Insulin Boluses in Type 1 Diabetes and Its Impact on Diabetes Control

“…Despite these limitations, the BOLUS measure offers promise as a measure of adherence that may be easily interpreted and may provide opportunities for provider-based interventions to improve adherence during clinic visits. 12 Ultimately, the BOLUS score would give providers a tool to assess adherence to therapy, focus on the importance of mealtime insulin administration, and potentially improve the glycemic control of their patients using insulin pumps.…”