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Coping Skills Training for Youths With Diabetes

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Abstract

The ability to self-manage diabetes is crucial for youths with type 1 diabetes and for the prevention of type 2 diabetes. However, such abilities are based not only in education but also in the acquisition of behavioral skills that assist with the application of such knowledge. This review describes a series of studies on a cognitive behavioral intervention called coping skills training, which is designed to enhance youths' ability to manage diabetes.
70 Diabetes Spectrum Volume 24, Number 2, 2011
In Brief
The ability to self-manage diabetes is crucial for youths with type 1 diabetes
and for the prevention of type 2 diabetes. However, such abilities are based
not only in education but also in the acquisition of behavioral skills that assist
with the application of such knowledge. This review describes a series of stud-
ies on a cognitive behavioral intervention called coping skills training, which
is designed to enhance youths’ ability to manage diabetes.
Margaret Grey, DrPH, RN, FAAN
Coping Skills Training for Youths With Diabetes
During the past 20 years, results of
several major trials have demonstrated
that intensive management of type
1 and type 2 diabetes can delay or
prevent the onset and progression of
many complications of the disease.1–3
It is also clear from such studies that
achiev ing good g lycemic control
requires mastering complex self-man-
agement skills and behaviors.
In ch i ldre n and adolesc ents ,
mastery of such skills is often com-
promised by normal development.
In adolescence, metabolic control
tends to deteriorate as a result of the
hormonal changes of adolescence
associated with insulin resistance4
and adolescent autonomy associated
with lower adherence to the treatment
regimen.5 Adolescence is marked by
rapid biological, physical, cognitive,
emotional, and social changes.6,7
Adolescents engage in experimen-
tation and risk-taking behaviors that
may adversely affect self-care and
clinical outcomes.8 Previous studies
have led to the conclusion that the
period of adolescence is often associ-
ated with neglect of self-monitoring,
nutrition therapy recommendations,
and pharmacological treatments.9,10
Such neglect in self-management is
usually not associated with a decit
in knowledge; rather, the cognitive
and developmental characteristics of
adolescence make appropriate decision
making more complex.11
Developmentally, adolescence is a
time for identity formation and sepa-
ration of self from families.12 The shift
from parental support to peer sup-
port is normal during adolescence.
However, it can place adolescents at
increased risk for poorer diabetes and
psychological adaptation.
Development of relationships with
peers is complicated for adolescents
who have type 1 diabetes or are at
risk for type 2 diabetes. Early ado-
lescents want to be seen as the same
as their peers and not to be treated
differently. There is a strong fear of
non-acceptance by the peer group
and exclusion from peer activities
that may make adolescents reluctant
to disclose their diagnosis.13 This fear
often causes adolescents to deliberately
miss blood glucose monitoring and
insulin injections or boluses, as well as
to eat additional foods without taking
the appropriate insulin, all of which
are associated with a decline in meta-
bolic control.14 Although research has
shown that friends provide valuable
emotional support to adolescents with
diabetes,15 many adolescents express
apprehension about friends’ reactions
to their diabetes-related self-manage-
ment tasks.16
Socia l co mpete nce has been
identified as an area of particular
vulnerability for adolescents with a
chronic illness that may interfere with
their ability to develop close peer rela-
tionships.17 In adolescents with or at
risk for diabetes, social competence
has been associated with better emo-
tional well-being,15 better ability to
manage stress, and better metabolic
control.18,19
Coping is a complex process that
can be dened as “constantly chang-
71
Diabetes Spectrum Volume 24, Number 2, 2011
FROM RESEARCH TO PRACTICE/BEHAVIORAL INTERVENTIONS FOR DIABETES SELF-MANAGEMENT
ing cognitive and behavioral efforts
to manage specific external and/or
internal demands that are appraised
as taxing or exceeding the resources
of the person.”20 According to Lazarus
and Folkman,20 the rst step in coping
is cognitive appraisal, which is crucial
to the impact of a particular disease on
a particular child. Having appraised
the situation, individuals can imple-
ment coping behaviors to reduce
distress or manage the problem.
Findings from studies in diabetes
indicate that greater use of avoidant
(or emotion-focused) coping strat-
egies such as wishful thinking in
response to stress is related to poorer
metabol ic control21 ,2 2 and poorer
psychosocial outcomes, including
lower reported quality of life, more
depressive symptoms, and lower social
competence.22 In contrast, greater use
of approach (or problem-focused)
coping strategies has been related to
better metabolic control and better
psychosocial adjustment in youths
with type 1 diabetes.23, 24 Similarly,
greater use of avoidant coping and
less use of approach coping has been
related to poorer adherence to treat-
ment regimen.25
More recent research on coping in
youths with other chronic conditions
supports a developmentally appropri-
ate model of stress and coping that
differentiates between controlled /
voluntary and automatic/involun-
tary responses to stress.26 This model
expands previous conceptualizations
of coping to include primary control
engagement coping, secondary control
engagement coping, disengagement
coping, and involuntary engagement
or stress reactivity (e.g., physiologi-
cal arousal or rumination).27 Primary
control engagement coping includes
attempts to change the problem or
one’s response to it (e.g., problem
solving or emotional expression);
secondary control engagement cop-
ing includes attempts to adapt to the
stressor (e.g., acceptance or distrac-
tion), and disengagement coping
includes avoidance, denial, and wish-
ful thinking. Previous research has
shown, for example, that higher levels
of secondary control engagement cop-
ing and lower levels of disengagement
coping were more effective for coping
with pain in a pediatric population.27
Cognitive-behavioral interventions
such as coping skills training focus
primarily on improving behavioral
skills necessary to self-manage and
achieve better glycemic and psychoso-
cial outcomes in patients with diabetes
and in their family members.
Coping Skills Training
Bandura28, 29 has suggested that indi-
viduals can actively influence many
areas of their lives. When people can
practice and rehearse a new behavior
such as learning how to cope success-
fully with a problem situation, their
self-efficacy or self-concept can be
enhanced. Furthermore, by enhancing
their self-efcacy, they may decrease
problems with psychosocial well-
being. When individuals cannot cope
effectively with a problem situation,
their condence is decreased for deal-
ing with the next problem, and they
use less successful coping patterns.30
Originally developed for work with
youths to prevent drug and alcohol use,
training in the use of coping skills can
teach personal and social behaviors
that can assist individuals in dealing
with potential stressors they encoun-
ter in their daily lives and the stress
reactions that may result from these
situations.31 In children and youths
without diabetes, such interventions
have been demonstrated to reduce
substance abuse,32 improve social
adjustment,33 prevent smoking,34 and
reduce responses to stressors.34 The
skills that are taught include social
problem solving, commun ic at ion
skills training (e.g., assertiveness and
social skills training), stress man-
agement, and cognitive-behavioral
modication.35
Social problem solving
Social problem solving is a process
by which individuals learn to think
through the steps of having a problem
and reaching a decision about how
to handle the problem. The process
helps individuals look at all possible
outcomes of situations and the pos-
sible consequences of their decisions.
For youths who tend to view problems
from a black-or-white perspective,
learning social problem solving can
help them see alternative solutions
when they are faced with peer or fam-
ily pressures or any situation in which
they are confronted with a dilemma.
Forman et al.32 identified six major
problem-solving steps: 1) identify the
problem, 2) determine goals, 3) gener-
ate alternative solutions, 4) examine
consequences, 5) choose the solution,
and 6) evaluate the outcome.
Communication skills training
Communication skills training aims
to help individuals express themselves
in ways that are clear, appropriate,
and constructive. Two main skills are
identified in communication skills
training: social skills training and
assertiveness training.
In social skills training, the aim is
to teach individuals how to work with
others in a way that will result in pos-
itive outcomes for all. Children and
adolescents tend not to ask directly for
what they need or want; often, they
say only what they do not want (e.g.,
“Don’t nag me about doing my glucose
tests.”) The steps used to teach social
skills training are 1) provide concrete
instructions on how to handle a social
situation, 2) allow participants to
witness a role-play of an appropriate
model, 3) have participants practice
their own role-play, 4) provide feed-
back on the participants’ role-play, 5)
give participants real-life practice, and
6) carry out group follow-up.
Asser t iveness traini ng allow s
for communication i n ways that
are direct, honest, and appropriate.
Working in a group setting allows
participants to observe the behavior
of others and to practice and obtain
feedback on how effectively they com-
municate with the other members of
the group.
Cognitive-behavioral modification
Cognitive-behavioral modication is
focused on understanding one’s own
thoughts and feelings and changing
self-dialogue to more positive mes-
saging. Children and adolescents
use an imaginary audience and often
think this audience is highly critical.
The three steps of cognitive-behav-
ioral modification—recognition of
thoughts and feelings, problem solv-
ing, and guided self-dialogue—help
youths to identify and change such
thoughts. The first step is to work
with individuals to reect on how they
think and respond to situations. The
individuals’ thoughts are examined
to consider whether the thoughts are
based on fact or assumption. Once
the thoughts are examined, the next
step is to solve the social problem. The
third step is to teach individuals to use
their thoughts to help follow through
on the decision they made in the pre-
vious step. The aim is to list negative
thoughts and formulate alternate posi-
tive thoughts to counter them.
72 Diabetes Spectrum Volume 24, Number 2, 2011
Stress management
Childhood and adolescence are stress-
ful, and youths with diabetes report
higher levels of stress than their peers
without diabetes. Thus, it is important
for them to learn stress management
techniques. The rst step in learning
stress management is to be able to
articulate the stressors in their lives.
Once stressors are identied, the train-
ing involves choosing an area in which
they can reallocate role responsibili-
ties to others or eliminate unnecessary
activities to reduce stress. Problem
solving can be used for reduc ing
stress by helping youths nd time for
themselves. Relaxation techniques are
taught, including breathing techniques
and guided imagery for altering men-
tal images and emotional responses.
Conflict resolution
Conict is a central feature of adoles-
cent life and is exaggerated in youths
with diabe tes . Development ally,
altho u g h ch i l d ren and adole s -
ce nts understand t hat there are
consequences of not taking care of
their diabetes, that knowledge is not
central to their behavior. This sets up
conict between parents and youths
over self-management behaviors.
Conf lic t resolution a llows for
the acquisition of skills necessary to
resolve conict in a positive manner.
The first step in this training is to
develop an understanding that, in any
conict, both parties can win and that
every conict should be approached
in this manner. Individuals are helped
to focus on clear communication
and problem-solving skills. Once the
conict is identied, all possible out-
comes and the consequences to these
outcomes are explored. Role-playing
can be used to model the appropriate
behavior.
Evidence for Coping Skills Training
With Children and Adolescents
In youths with type 1 diabetes, edu-
cational programs that emphasize
factual knowledge about the disease
process have had disappointing results
in improving psychosocial and clinical
outcomes when compared to behav-
ioral interventions.36 Coping skills
training increases competence and
mastery by retraining inappropriate
or nonconstructive coping styles and
patterns of behavior toward the devel-
opment of constructive behaviors.
Using coping skills training for
youths with type 1 diabetes was based
on the hypothesis that improving
coping skills would improve youths’
ability to cope with the problems they
face on a day-to-day basis in man-
aging diabetes. In the early 1980s, a
number of pre-experimental studies of
coping skills training were conducted
with 5–10 school-aged children and
preadolescents.19, 37,38 These studies
suggested that coping skills training
increased appropriate verbal asser-
tiveness and performance in social
situations but did not improve self-
management or glycemic control.
Several experimental pilot studies
also supported the potential of this
intervention to help children and ado-
lescents manage diabetes. In one of
these studies,39 diabetes-specic stress
was found to decrease significantly
after stress management training, but
glycemic control, coping styles, self-
efficacy, and adherence to regimen
remained unchanged.
Mendez and Belendez36 compared
the effect of adolescents receiving
routine medical care (n = 19) to a
behavioral intervention (n = 18) using
a pre- and post-test design with a non-
equivalent control group. The 12-week
intervention included problem-solving
strategies, role-playing, social skills
training, exercise, diet, glucose test-
ing, and insulin administration. The
experimental group demonstrated
signicant improvement in barriers to
adherence, severity of daily hassles,
skill at and frequency of blood glu-
cose testing, and degree of uneasiness
in social interaction. These improve-
ments were maintained during 13
months. Patients’ knowledge of glu-
cose testing, insulin administration,
diet, and diabetes pathophysiology
were also improved.
Grey et al.40 reported the results
of a prospective randomized clini-
ca l trial conduc ted to determine
whether coping skills training would
improve glycemic and psychosocial
outcomes in adolescents with type
1 diabetes implementing intensive
diabetes management. In these stud-
ies, subjects were randomly assigned
to receive coping skills training or
enhanced education in addition to
intensive management of diabetes.
The studies examined the short-term
effects of coping skills training as an
adjunct to intensive therapy in adoles-
cents (n = 65) between the age of 13
and 20 years (mean 16.5 years) who
elected to initiate intensive diabetes
management. At 3 months, results
demonstrated that adolescents who
received coping skills training had
lower A1C levels, better diabetes self-
efcacy, and less distress about coping
with their diabetes than adolescents
receiving intensive management alone.
In addition, adolescents who received
coping skills training found it easier
to cope with their diabetes and expe-
rienced less of a negative impact from
diabetes on their quality of life than
those who did not receive the training.
The long-lasting effects of coping
skills training on glycemic control
and quality of life for adolescents with
type 1 diabetes were examined in this
same cohort of subjects.41 The ques-
tion studied was whether the initial
effects on glycemic control and qual-
ity of life associated with coping skills
training combined with intensive dia-
betes management could be sustained
for 1 year. The sample for this analysis
included 77 subjects (43 females, 95%
white) who were 12–20 years of age
(mean 14.2 years) and had a mean
duration of diabetes of 8.7 years. At
the 1-year follow-up, subjects in the
coping skills training group had sig-
nicantly lower A1C levels, improved
diabetes and medical self-efcacy, and
a lower impact of diabetes on their
quality of life than youths receiving
routine diabetes care in the control
group. In male subjects, coping skills
training did not affect adverse out-
comes such as hypoglycemia, diabetic
ketoacidosis, or weight gain, but in
female subjects, coping skills training
decreased the incidence of weight gain
and hypoglycemic episodes.
Building on this work, Grey et al.42
studied whether providing coping
skills training to preadolescent youths
with type 1 diabetes would reduce
problems as they enter adolescence.
The purpose of this randomized trial
(n = 82) was to determine the effects,
mediators, and moderators of a cop-
ing skills training intervention for
school-aged children compared to gen-
eral diabetes education. Both groups
improved over time, reporting lower
impact of diabetes, better coping with
diabetes, better diabetes self-efcacy,
fewer depressive symptoms, and less
parental control. Treatment modal-
ity (pump vs. injections) moderated
intervention efficacy on select out-
comes, with those on pumps who
received coping skills training having
lower A1C over time. The ndings of
this study suggested that group-based
73
Diabetes Spectrum Volume 24, Number 2, 2011
FROM RESEARCH TO PRACTICE/BEHAVIORAL INTERVENTIONS FOR DIABETES SELF-MANAGEMENT
interventions may be benecial for this
age-group.
Although it is recognized that car-
ing for a child with type 1 diabetes
is stressful for parents, few interven-
tions have been developed and tested
for this population. Thus, the purpose
of another study43 was to compare
a g roup educational intervention
for parents of children with type 1
diabetes to a coping skills training
intervention. Parents (n = 181) were
randomized to education or coping
skills training conditions. Parents
completed measures of family con-
flict, responsibilit y for treatment,
coping, and quality of life at baseline,
3 months, 6 months, and 12 months
after the intervention. Clinical data
(i.e., A1C) were collected from chil-
dren’s medical records before and after
the intervention. There were no sig-
nicant treatment effects 12 months
after the intervention, but parents in
both groups reported significantly
improved coping, less responsibil-
ity for treatment management, and
improved quality of life. Although
children’s metabolic control worsened
over time as would be expected with
the onset of puberty, mean values at
12 months were still within the rec-
ommended levels (A1C > 8%). These
results suggest that group-based inter-
ventions for parents of children with
type 1 diabetes may lessen the nega-
tive impact of diabetes management
as youths transition to adolescence.
More recently, in an effort to make
the coping skills training program
more accessible to youths, Whittemore
et al.44 described the development of
an Internet version of the program
(TEENCOPE). Preliminary results
suggest that multiethnic (n = 163,
48% male, 11.7% African-American,
27% Hispanic) teens aged 11–14 years
(mean 12.2 years) found the program
acceptable and participate at high
rates.45 The participation rate was
85%, and there was 86% adherence to
completion of all sessions of the inter-
vention online. After 6 months, 79%
of youths were retained, and 52% had
participated in the discussion board. A
multisite clinical trial is in progress in
which TEENCOPE is being compared
to a diabetes problem-solving Internet-
based program.
Taken as a group, these studies
suggest that in children and adoles-
cents with type 1 diabetes, coping
skills training increases the repertoire
of skills that youths have to cope with
diabetes. By doing so, better glycemic
control and improved quality of life
are possible through the improved
ability to solve problems and maintain
self-management behaviors.
Type 2 diabe tes in youth is a
relatively new phenomenon, but it
represents an increasingly substantial
proportion of youths newly diagnosed
with diabetes.46 Although there have
been few large-scale studies of type 2
diabetes prevention or management
in youths with the exception of the
TODAY study,47 our group recently
conducted a smaller efcacy trial of a
multifaceted, school-based interven-
tion (nutrition and physical activity
education and coping skills training)
aimed at prevention of type 2 diabe-
tes in a high-risk, minority population
(n = 198, 55% African-American,
42% Hispanic) of adolescents at risk
for type 2 diabetes by virtue of obesity
and family history of diabetes.48
In this study, schools were ran-
domized to two intervention groups
to avoid individual contamination:
educational intervention with or
without the addition of coping skills
training and health coaching. Students
were followed for 12 months. Results
showed that students in both groups
had some improvement in anthropo-
metric measures, lipids, and depressive
symptoms during 12 months. Students
who received coping skills training had
greater improvement on some indica-
tors of metabolic risk as determined by
oral glucose tolerance tests compared
to students who received education
only. Although more work is war-
ranted, these data suggest that the use
of coping skills training techniques
may also be useful in developing self-
management skills for prevention of
type 2 diabetes in high-risk youths.
Discussion
The results of these studies of coping
skills training interventions in chil-
dren and adolescents with or at risk
for diabetes have led to the conclusion
that these interventions are effective
in assisting youths to improve coping
with diabetes and to achieve better
diabetes outcomes. As more health
care providers and patients aim for
improved glycemic control and qual-
ity of life, the addition of coping skills
training to usual diabetes self-man-
agement programs may be helpful in
aiding children and adolescents as
they strive to achieve and maintain
treatment goals. In addition to pro-
viding coping skills training in groups,
preliminary studies suggest that these
techniques can be adapted not only to
clinic and school settings, but also in
Internet and social media formats that
represent the way youths communi-
cate. Such interventions are aimed at
preventing serious problems that may
emerge during early adolescence and
are difcult to correct.49
There are limitations to the lit-
er atu re on stre ss and coping in
diabetes. Controversy surrounds the
measurement of coping using global,
retrospective questionnaires or real-
time self-reports. There are also design
issues in that most studies are cross-
sectional and not longitudinal. Some
experimental studies are not explicitly
derived from a particular theoretical
approach. Furthermore, the coping
skills taught in the studies described
here are based on the empirical lit-
erature involving cross-sectional and
longitudi nal studies, but they do
not represent a unified theoretical
approach to coping.
Alt hough more e xper imental
rese arch is nee ded, espec ially in
minority populations and on the ef-
cacy and effectiveness of coping skills
training delivered via social media, the
addition of coping skills training inter-
ventions to the clinical care of children
and adolescents with diabetes appears
warranted. Such interventions can be
incorporated into routine diabetes
education programs or the content
included in regular diabetes care visits.
Interventions using coping skills
training and problem solving for
children and adolescents and their
families should be individualized to
their lifestyle. A key element of using
coping skills training in practice is to
avoid telling youths what to do, but
instead to help them develop alterna-
tives with the clinician’s support. In
the context of busy practice, such an
approach takes more time but may
support youths in making better deci-
sions at home.
Behavioral theory should be used
in the design of future studies to
increase the understanding of behavior
change in the self-management of dia-
betes. Behavioral interventions must
be practically designed, be feasible in
a variety of settings, reach multiethnic
populations, measure long-term physi-
ological and psychosocial outcomes,
and be cost-effective. Future research
must use high methodological quality,
study diverse populations and settings,
74 Diabetes Spectrum Volume 24, Number 2, 2011
and use interventions that are gener-
alizable to test the effectiveness of
interventions in relation to glycemic
control, quality of life, and depression.
Acknowledgments
This article was supported by grants
from the Nat ion a l I n stit ute s o f
Health and National Institute for
Nursing Research (1R01NR004009-
1- 1 6 , 1 R 0 1 N R 0 08 2 4 4 , a n d
1RCNR011594).
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... A literatura indica que o autocuidado de crianças e adolescentes está associado a melhores resultados no tratamento do DM1 (Grey, 2011;Guo et al., 2011) e que há preditores consistentes desse tipo de comportamento em crianças e adolescentes com DM1. Baixos índices de autocuidado foram mais constatados em grupos étnicos minoritários e de baixo nível socioeconômico. ...
... Esses achados ressaltam indicadores da evolução da doença (Goethals et al., 2017;Hannonen et al., 2019;Landers et al., 2016), enquanto outros não chegaram a esse resultado (Butler et al., 2007;Greene et al., 2010). Em resumo, a literatura mostra que crianças com DM1 que praticam o autocuidado têm melhores índices de controle glicêmico e qualidade de vida (Grey, 2011;Guo et al., 2011), assim como indica que o engajamento infantil em práticas de autocuidado pode ser influenciado pelas práticas parentais (Neylon et al., 2013). Contudo, as relações entre diferentes formas de controle parental e o autocuidado ainda não foram esclarecidas, particularmente no contexto do DM1. ...
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Introdução: O autocuidado em crianças portadoras de doenças crônicas pode ser promovido ou prejudicado pelo comportamento parental. O objetivo deste estudo foi analisar as relações entre as práticas maternas de controle (suporte apropriado vs. controle psicológico) e o autocuidado em crianças com diabetes mellitus tipo 1 (DM1). Método: Participaram 23 mães de crianças portadoras de DM1, que responderam a uma entrevista semiestruturada sobre práticas de controle materno e ao Questionário da Rotina Pediátrica do Diabetes, que avaliou o autocuidado das crianças. Resultados: o suporte apropriado da mãe, especialmente quando expresso em explicações, encorajamento e afeto positivo, foi um preditor efetivo do autocuidado infantil. Discussão: o suporte apropriado favorece a conquista de autonomia por parte da criança, que se torna progressivamente mais capaz de cuidar da própria saúde. Conclusões: programas de intervenção para crianças portadoras de DM1 e suas famílias devem promover práticas de suporte apropriado nos pais.
... Similarly, Rassart et al. [14] examined the perceived benefits of diabetics aged 10 to 14 using a questionnaire study and emotions. In adolescents with diabetes, this is associated with worse metabolic control and treatment adherence [16]. Similarly, Pisula and Czaplinska [17] found frequent use of the Ignore the problem and Avoidance oriented coping strategy in adolescents, both in adolescents with diabetes and in healthy peers. ...
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Aim. The study aimed to identify the presence of posttraumatic growth in children and adolescents with the diabetes mellitus type I and to find out relations with coping strategies. Material and methods. The research group was formed by 102 children aged 12-18 years with diabetes mellitus type I. The research design was a cross-sectional study. The Posttraumatic Growth Inventory for Children (PTGI-C) and the Ways of Coping Questionnaire (WCQ) were used for data collection. Results. The ways of coping with stress are related to the subsequent posttraumatic growth in children and adolescents with type 1 diabetes. The strongest correlation was found between posttraumatic growth and coping strategies Seeking Social Support and Planful Problem-Solving. The correlation between posttraumatic growth and coping strategy Escape-Avoidance has not been identified. However, this strategy was most often used by adolescents. There was no difference in the level of posttraumatic growth with respect to sex of the respondents and their age, except for the area of Personal Strength and area of Spiritual Change. Conclusions. The facilitation of effective coping strategies by a nurse can have a positive effect on the posttraumatic growth of children and adolescents with diabetes.
... Adaptive coping strategies can help maintain good health outcomes, such as glycaemic control [13]. In contrast, maladaptive strategies such as wishful thinking and avoidant can affect metabolic control and psychosocial outcomes such as quality of life and depressive symptoms [7,13,14]. ...
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Background Utilising coping strategies to reduce and manage the intensity of negative and distressing emotions caused by diabetes is essential. However, little is known about the use of coping strategies among people living with diabetes in Sub-Saharan African countries like Zambia. This study investigates coping strategies used by people with diabetes in Zambia and how these are associated with diabetes-specific emotional distress, depression and diabetes self-care. Methods Cross-sectional data from 157 people with diabetes were collected. Coping styles were measured using the Brief COPE, distress using the Problem Areas in Diabetes, depression using the Major Depression Inventory and self-care using the Diabetes Self-Care scale. Results Data showed that adaptive coping strategies were the most frequently used coping strategies among Zambian individuals with diabetes. Maladaptive coping strategies were related to increased diabetes distress and depression. Emotional support was related to better diabetes self-care, while self-blame was related to poor diabetes self-care. Conclusion There is a need to help individuals with diabetes identify adaptive strategies that work best for them in order to improve their quality of life.
... Therefore, considering simulation and problem-solving methods might be useful for future education programmes for younger people. 27 The study findings have also provided some valuable suggestions for improving recruitment to future studies. Previous studies have shown that engaging this population in diabetes care or education can be challenging, and young people cite reasons such as 'Had other things to do', 'No time', 'Could not get time off school/college or work', 'Learnt about diabetes from other sources' or 'Feel able to cope on own' for not participating. ...
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Background: Adolescence is a challenging time for young people with Type 1 diabetes, associated with worsening glycaemia and disengagement with care. To improve support, we co-designed with young people a novel psychosocially modelled programme of diabetes education (the Youth Empowerment Skills [YES] programme). This study aimed to estimate the clinical impact and feasibility (recruitment, retention and participant experiences) of this programme. Methods: A pilot study using mixed-methods was conducted to assess process and outcomes, involving a pre- and post-exposure assessment of glycaemic control, programme participation data, service utilisation and qualitative semi-structured interviews (analysed using Framework Analysis). Participants were recruited from two hospital diabetes centres in Southeast London. The intervention was conducted in local community centres. Participants were young people with Type 1 diabetes aged 15–21 years. The YES programme involves contact with an outreach youth worker and attending a 3-day psychologically modelled course encompassing social learning, peer facilitation and simulation exercises. The primary outcome was change in HbA1c at 6 and 12-months post-intervention. Secondary outcomes included diabetes-related hospital admissions and incident diabetic ketoacidosis (DKA). Results: Twenty-six young people participated in the programme, mean age 18 (±1.7) years. Uptake was 34% (n = 26) of those approached, with 96% (n = 25) programme completion. Pre-exposure (12 month mean) HbA1c was 93.5 (±29.7) mmol/mol (10.7%), and at 12 months post-exposure, it was 85.1 (±25.4) mmol/mol (10%) (P = 0.01), with 46% (n = 12) of participants achieving a reduction in their HbA1c ≥5.5 mmol/mol (0.5%). Unplanned hospital admissions and DKA rates reduced by 38 and 30%, respectively. The qualitative data identified positive psychosocial impacts including increased diabetes engagement and activation. Active ingredients were social learning, peer support and experiential learning. Participants emphasised the importance of the youth worker in engaging with the programme. Conclusion: The evaluation indicates that the YES programme helps improve young people’s self-confidence in managing diabetes, enhances diabetes engagement and improves clinical outcomes.
... Adaptive coping strategies such as acceptance and active coping can help maintain good health outcomes, such as glycaemic control [15]. In contrast, maladaptive strategies such as wishful thinking and avoidant can affect metabolic control and psychosocial outcomes such as quality of life and depressive symptoms [15][16][17]. Adaptive and maladaptive coping strategies can either be problem-focused or emotional-focused. Problem-focused coping refers to efforts directed toward rational management of a problem, and it is aimed at changing the situation causing distress whereas emotionfocused coping pertains to efforts to reduce emotional distress caused by the stressful event and manage or regulate emotions that might accompany or result from the stressor. ...
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Objectives Utilising coping strategies to reduce and manage the intensity of negative and distressing emotions caused by diabetes is essential. However, little is known about the use of coping strategies among people living with diabetes in Sub-Saharan African countries like Zambia. This study investigates coping strategies used by people with diabetes in Zambia and how these are associated with diabetes-specific emotional distress, depression and diabetes self-care. Methods Cross-sectional data from 157 people with diabetes aged between 12 and 68 years were collected. Of the 157, 59% were people with type 1 diabetes and 37% with type 2 diabetes. About 4% had missing information in their record but had either type 1 or type 2 diabetes. Coping styles were measured using the Brief Version of the Coping Orientation to Problems Experienced (Brief COPE), diabetes specific-distress using the Problem Areas in Diabetes, depression using the Major Depression Inventory and self-care using the Diabetes Self-Care scale. Results Data showed that adaptive coping strategies such as religious coping, acceptance among others, were the most frequently used coping strategies among Zambian individuals with diabetes. Maladaptive coping strategies e.g., self-blame and self-distraction were related to increased diabetes specific-distress and depression. Emotional support was related to better diabetes self-care, while self-blame was related to poor diabetes self-care. Conclusion There is need to help individuals with diabetes identify adaptive strategies that work best for them in order to improve their quality of life.
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Introduction: Diabetes, as the most common chronic metabolic disease, causes a crisis in life, which increases the use of spiritual protection as a coping mechanism. Spiritual health is one of the variables that enhance the sense of coherence. The aim of this study was to investigate the spiritual health and sense of coherence in type 2 diabetic patients. Methods: This study is a descriptive-correlational. In 1396, 120 patients with type 2 diabetes who were referred to the emergency department of Abhar city were selected using available sampling method. The demographic, spiritual health and sense of coherence questionnaire was used. Data were analyzed using SPSS16 software, descriptive and inferential statistical tests, Pearson and Anova. Results: Patients' spiritual wellbeing showed that mean of spiritual well-being was 96.2% and 57.5% had high spiritual health. The mean of sense of coherence was 116 in patients, and Pearson test showed a significant positive correlation between spiritual health and sense of coherence. Conclusions: Regarding the chronic nature of diabetes, it seems that spiritual health is an effective factor in improving the sense of coherence and, consequently, reducing psychiatric problems and complications arising from it.
Chapter
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Social skills training was used to develop effective social coping skills in 5 9–12 yr old preadolescent insulin-dependent diabetics. Multiple baseline analyses revealed marked changes in target behaviors. In addition, the effects of treatment generalized to untrained role-play scenes and a real-life situation. (18 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study evaluated the relationship of general and diabetes-specific conflict with diabetes self-care in adolescents with Type 1 diabetes within the context of family structure and parental employment. The study addressed (a) whether family structure and maternal employment were associated with diabetes-specific and general conflict and diabetes self-care and (b) the relationship of conflict with self-care adherence. Participants were 161 adolescents ages 11-15 years with Type 1 diabetes. Diabetes-specific family conflict, mother-adolescent general conflict, and self-care adherence were assessed. Results indicated that neither family structure nor maternal employment groups differed on any of the measures of conflict or on self-care adherence. Neither general conflict nor diabetes-specific conflict was related to self-care adherence. Caution should be exercised in drawing conclusions about the relationships of family structure, maternal employment, and conflict with self-care management of diabetes in this age group. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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279 high-risk secondary school students completed one of the following treatment conditions: (1) coping skills school intervention, (2) coping skills school plus parent intervention, or (3) comparison control. Ss in the coping skills conditions improved on a measure of coping skills acquisition, whereas those in the control group did not. All Ss improved on a variety of personality and school behavior variables. There were some modest increases in self-report of substance use; however, these were smaller than would be expected in a high-risk population over the study period. The findings suggest that preventive intervention with high-risk youth has some positive effect on risk factors, although the differential efficacy of coping skills training with high-risk youth was not supported. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
BACKGROUND Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. METHODS A total of 1441 patients with IDDM -- 726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. RESULTS In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of ≥ 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of ≥ 300 mg per 24 hours) by 54 percent (95 percent confidence interval, 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. CONCLUSIONS Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.