Diabetes mellitus in the transition to adulthood: Adjustment, self-care, and health status

Department of Pediatrics, Ohio State University, Children's Hospital, Columbus 43205.
Journal of Developmental & Behavioral Pediatrics (Impact Factor: 2.13). 07/1992; 13(3):194-201. DOI: 10.1097/00004703-199206000-00007
Source: PubMed


A cross-sectional study of health and adjustment among 18 to 22-year-old patients with insulin-dependent diabetes mellitus (IDDM) is reported. Objectives were to examine coping with IDDM in this age group; to identify predictors of health status, treatment adherence, and health care use; and to provide a retrospective evaluation of the persistence of IDDM-specific adjustment from earlier through later adolescence. Multiple validated measures, interviews of independent informants, and biochemical assays were used to assess psychological, behavioral, and metabolic status. Patients and parents completed a retrospective measure of the patient's adjustment to IDDM during earlier adolescence. Findings (n = 81) indicated: (1) normal rates of general psychopathology but some evidence of poorer adjustment to IDDM relative to other age groups, (2) poor diabetic control and high incidence of microalbuminuria, (3) specific factors associated differentially with treatment compliance, health care use, diabetic control, and microalbuminuria among late adolescents, and (4) evidence that poor adjustment to IDDM in earlier adolescence persists into the transition to adulthood. The findings imply that late adolescents with IDDM are at risk of various unfavorable behavioral and health outcomes and that adjustment to the disease during earlier adolescence may be a predictor of subsequent health-related behavior and health status. A longitudinal study is needed to confirm these findings.

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    • "There are individual differences in preferences between adolescents with chronic health conditions (Jedeloo et al. 2010). Transition between pediatric and adult care for adolescents with chronic health conditions is often poorly managed, with negative consequences on health and quality of life outcomes (Betz 2004; Lotstein et al. 2008; McDonagh 2005; Oeffinger et al. 2005; Reiss et al. 2005; Wojciechowski et al. 2002; Watson 2000; Wysocki et al. 1992; Yeung et al. 2008). As young people mature and their medical and personal needs change, it is important that they receive age-appropriate healthcare tailored to their medical and personal needs in order to protect their quality of life (While et al. 2004). "
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    ABSTRACT: This study aimed to identify the relationship between satisfaction with transitional care and quality of life of chronically ill adolescents over time. This longitudinal study included adolescents with type I diabetes, juvenile idiopathic arthritis (JIA), and neuromuscular disorders (NMD). At baseline 138 respondents (response rate 31 %) filled in a questionnaire and 188 about 1 year later (response rate 43 %). Analysis of variance showed that adolescents with diabetes reported the highest physical quality of life, followed in order by those with NMD and JIA (p ≤ 0.01). Adolescents with diabetes reported the highest social quality of life, followed in order by those with JIA and NMD (both at p ≤ 0.001). Univariate analyses showed that satisfaction with transitional care at T0 was significantly related to emotional and physical quality of life at T1 (both at p ≤ 0.05). At T1, satisfaction with transitional care was significantly related to the emotional, physical, and social domains of quality of life (all at p ≤ 0.001). Multiple regression analyses revealed that satisfaction with transitional care at T1 was related to emotional (β -0.20; p ≤ 0.05) and social (β -0.35; p ≤ 0.01) quality of life domains over time. This indicates that lower gap scores, which measured differences between 'best care' and 'current care,' are associated with better social and emotional quality of life in this sample of adolescents. Satisfaction with transitional care and social and emotional quality of life are related over time.
    Applied Research in Quality of Life 12/2013; 8(4):481-491. DOI:10.1007/s11482-012-9209-3 · 0.82 Impact Factor
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    • "We concluded that treatment compliance was therefore important in order to maximise patient outcomes and minimise the risk of premature death. In type 1 diabetes, certain groups of patients, such as adolescents and young adults, may be less compliant with medication for reasons such as fear of hypoglycaemia (Di Battista, Hart, Greco, & Gloizer, 2009) or weight gain from insulin use (Bryden et al., 1999), lack of understanding of long-term complications (Dovey-Pearce, Hurrell, May, Walker, & Doherty, 2005), the impact of self-management upon lifestyle (Lancaster et al., 2010) and issues surrounding the change from paediatric to adult care services (Wysocki et al., 1992). However, the effect of treatment compliance on mortality in type 1 diabetes has not been previously described. "
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    ABSTRACT: Aims: To determine if a diagnostic record of poor treatment compliance (medication non-compliance and/or non-attendance at medical appointments) was associated with all-cause mortality in people with type 1 diabetes. Methods: This is an observational cohort study of data extracted from The Health Improvement Network (THIN) database, comprising data on patients served by over 350 primary care practices in the U.K. Participants were included in the study if they had diagnostic codes indicative of type 1 diabetes. Treatment non-compliance was defined as missing one or more scheduled appointment, or one or more codes indicating medication non-compliance. Results: Of 2946 patients with type 1 diabetes, 867 (29.4%) had a record of either appointment non-attendance or medication non-compliance in the 30 month compliance assessment period. The crude, unadjusted mortality rate for those patients who were treatment non-compliant was 1.462 (95% CI 0.954-2.205). Following adjustment for confounding factors, treatment non-compliance was associated with increased all-cause mortality (HR=1.642; 95% CI 1.055-2.554). Conclusions: Treatment non-compliance was associated with increased all-cause mortality in patients with type 1 diabetes. Understanding and addressing factors that contribute to patient treatment non-compliance will be important in improving the life expectancy of patients with type 1 diabetes.
    Journal of diabetes and its complications 11/2012; 27(3). DOI:10.1016/j.jdiacomp.2012.10.006 · 3.01 Impact Factor
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    • "It is interesting that consequences of assuming responsibility can be both positive and negative; that is, there can be difficulties as well as positive outcomes. The consequence of poor management has received considerable focus in the literature and it is well documented that it is an issue for adolescents with type 1 diabetes (Anderson et al., 1990; Anderson, Ho, Brackett, Finkelstein, & Laffel, 1997; Bearman & La Greca, 2002; Du Pasquier-Fediaevsky, Chwalow, & Tubiana-Rufi, 2005; Hanson, Henggeler, & Burghen, 1987a, 1987b; Harris et al., 2000; Jacobson et al., 1990; Jacobson et al., 1987; Johnson, Silverstein, Rosenbloom, Carter, & Cunningham, 1986; La Greca et al., 1995; Miller-Johnson et al., 1994; Wysocki, Meinhold et al., 1992). The focus for clinicians and researchers has been on diabetes management, which is critical in the maintenance of metabolic control and the reduction of serious health consequences such as retinopathy, nephropathy, neuropathy, and cardiovascular disease (Diabetes Control and Complications Research Group, 1994). "
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    ABSTRACT: This concept analysis clarifies "assuming responsibility for self-care" by adolescents with type 1 diabetes. Walker and Avant's (2005) methodology guided the analysis. Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making. Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.
    Journal for Specialists in Pediatric Nursing 04/2010; 15(2):99-110. DOI:10.1111/j.1744-6155.2009.00218.x · 0.92 Impact Factor
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