Psychological factors associated with diabetes self-management among adolescents with Type 1 diabetes: A systematic review

Abstract

This review aims to synthesise the literature examining the psychosocial variables related to self-management (insulin adherence, non-adherence and administration, blood sugar monitoring, dietary behaviour, exercise behaviour) in adolescents with type 1 diabetes.A systematic search of three electronic databases was carried out and, after the application of eligibility criteria, 21 articles were assessed for quality prior to data extraction. Numerous psychological factors were found to be associated with self-management; however, correlations were typically small to moderate. The strongest associations were found between social anxiety and diet (among males); greater intrinsic motivation, conscientiousness and diet; and extraversion and exercise. Keywords:Diabetes; adolescence; adherence; diet; exercise behaviour Running head: Psychological factors and adolescent diabetes 3 Type 1 diabetes is a common chronic illness affecting young people in the UK, and its incidence is increasing (Patterson et al., 2012). Although the importance of good glycaemic control to prevent vascular complications (such as retinopathy, neuropathy, and nephropathy) is well recognised, currently in the UK fewer than 25% of children and young adults achieve the target for long-term glycaemic control (HbA1c < 7.5 without frequent hypoglycaemia) (Health & Social Care Information Centre, 2013). Given the plethora of short and long term physical health difficulties related to Type 1 diabetes, it is crucial that young people learn to manage their diabetes effectively, as any decrease in HbA1c decreases the risk of complications (Lind et al., 2009).However, diabetes management in the adolescent age group presents a more complex set of challenges given the range of physiological, social and emotional changes which occur between childhood and adulthood, including puberty, peer pressure, a desire to be "normal", identity formation and, often, testing of boundaries set by healthcare professionals, parents and caregivers .Interventions have focused on enabling young people to better manage their condition. Historically, this has taken the form of educational programmes aimed at teaching specific diabetes management skills and fostering independence with these tasks (for example, carbohydrate counting, blood glucose monitoring), or psychosocial interventions aiming to address self-care and emotional difficulties through a variety of problem-solving and emotion-focused techniques (Peyrot & Rubin, 2007).In 2000, the UK National Health Service Health Technology Assessment programme published a systematic review of the literature on the effectiveness of psychosocial and educational interventions for adolescents with diabetes . The review described small to medium-sized beneficial effects on diabetes management outcomes, but highlighted numerous weaknesses within the literature -more than half the studies (55%) had Running head: Psychological factors and adolescent diabetes 4 no theoretical basis underlying the intervention. A subsequent review (Mur...

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence

“…Most aspects of optimal care of adolescents with diabetes have not been subjected to rigorous enquiry, hence results are sometimes conflicting. This perhaps is reflective of the variable findings associated with factors likely to achieve optimal adolescent adherence and self‐management …”

“…This perhaps is reflective of the variable findings associated with factors likely to achieve optimal adolescent adherence and selfmanagement. 38 Extensive review of psychoeducational interventions has concluded that they may have modest benefit on psychological outcomes but not on glycemic control, although the methodological quality of most studies was moderate to poor. [39][40][41] Recent robustly designed randomized controlled trials of motivational interviewing interventions through training programs for pediatric diabetes teams appear to lead to no improvement in either psychosocial measures or HbA1c levels.…”

Apego y estrés en niños con Diabetes tipo 1 y sus madres

“…Existe creciente evidencia acerca del rol del estrés en el curso de la diabetes mellitus tipo 1 (DM1) 1 . La relación entre estrés y DM1 se entiende como bidireccional (figura 1): la carga por el diagnóstico y el tratamiento de la DM1 son causa de estrés 2 y a su vez el estrés puede ser causa de desregulaciones en el control de la diabetes de manera directa (vía mecanismos fisiológicos ligados al control metabólico) 2 o indirecta (mediante una disminución en la adherencia al tratamiento) 3 .…”

Adherence and barriers in e‐health self‐control training for enhancing childhood multidisciplinary obesity treatment

“…The Barriers-to-Treatment Model (1997) is one of the few comprehensive frameworks that can be used to detect both relevant context determinants of adherence, additionally to individual characteristics. This model is still valid today, because evidence points out the importance of life events (Martinez et al, 2018), support of the close environment (Cheiloudaki & Alexopoulos, 2019;Cook, Schmiege, Bradley-Springer, Starr, & Carrington, 2018), and relevance of beliefs, attitudes, self-efficacy, and motivation (Cook et al, 2018;Matsuzawa et al, 2019). When barriers add up, treatment gains are becoming too limited in comparison to the effort, which might lead to nonadherence because of (a) practical obstacles (e.g., time constraints), (b) treatment demands (e.g., frequency of sessions), (c) perceived relevance issues (e.g., doubts on usefulness), (d) problems in the therapeutic relationship (e.g., limited contact), and (e) stressful events (e.g., parental divorce; .…”