Predictors of Self-Management in Pediatric Type 1 Diabetes: Individual, Family, Systemic, and Technologic Influences
Type 1 diabetes (T1D) is a complex chronic disease that has many facets for successful management. The burden of this management falls largely on the individual and their family members. Self-management has a major influence on T1D health outcomes, and with successful management, children and adolescents with T1D can lead long and healthy lives. We discuss how various individual, family, and systemic/technologic factors influence T1D self-management, providing research that supports interventions targeting each of these factors. With this information, health care practitioners and researchers can better understand the role of T1D self-management and bolster this important aspect of T1D care.
KeywordsDiabetes Self-management Individual Family Systems Technology
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Conflict of Interest
Diana Naranjo, Shelagh Mulvaney, Maureen McGrath, Theresa Garnero, and Korey Hood declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 4.••Jacobson AM, Braffett BH, Cleary PA, Gubitosi-Klug RA, Larkin ME. The long-term effects of type 1 diabetes treatment and complications on health-related quality of life: a 23-year follow-up of the diabetes control and complications/epidemiology of diabetes interventions and complications cohort. Diabetes Care. 2013;8:8. This is a landmark trial showing the importance of tight glucose control and lasting effects across 23 years.Google Scholar
- 6.•Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics. 2009;124(6):e1171–9. Comprehensive review of self-management and gylecmic control, including all of the latest studies and an evaluation of relative importance of various adherence strategies].PubMedCrossRefGoogle Scholar
- 10.Quittner AL, Modi AC, Lemanek KL, Ievers-Landis CE, Rapoff MA. Evidence-based assessment of adherence to medical treatments in pediatric psychology. J PediatrPsychol. 2008;33(9):916–36.Google Scholar
- 21.Phillip M, Battelino T, Rodriguez H, Danne T, Kaufman F. Use of insulin pump therapy in the pediatric age-group: consensus statement from The European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2007;30(6):1653–62.PubMedCrossRefGoogle Scholar
- 36.•Helgeson VS, Escobar O, Siminerio L, Becker D. Relation of stressful life events to metabolic control among adolescents with diabetes: 5-year longitudinal study. Health Psychol. 2010;29(2):153–9. Clearly delineates the effects of stress on control and self-management over time when most studies examining this have been cross-sectional.PubMedCentralPubMedCrossRefGoogle Scholar
- 43.••Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health: Off Publ Soc Adolesc Med. 2013;52(1):28–34. Important findings linking perceived quality of life as a barrier to effective diabetes management, which impacted diabetes control.CrossRefGoogle Scholar
- 46.••Hood KK, Rohan JM, Peterson CM, Drotar D. Interventions with adherence-promoting components in pediatric type 1 diabetes: meta-analysis of their impact on glycemic control. Diabetes Care. 2010;33(7):1658–64. A well carried out meta-analysis that clearly reviews multiple large-scale interventions, finding that those that have a multi-component, behavioral, skill-building emphasis are the most effective.PubMedCentralPubMedCrossRefGoogle Scholar
- 48.Anderson B, Ho J, Brackett J, Finkelstein D, Laffel L. Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. J Pediatr. 1997;130(2):257–65.PubMedCrossRefGoogle Scholar
- 62.Grey M. Interventions for children with diabetes and their families. Ann Rev Nurs Res. 2000;18:149–70.Google Scholar
- 68.Certification CfCM. 2005.Google Scholar
- 73.Madden M, Lenhart A, Duggan M, Cortesi S, Gasser U. Teens and Technology 2013: Pew Research Center; 2013Google Scholar
- 77.Kumah-Crystal Y, Mulvaney SA. Utilization of blood glucose data in patient education. Current Diabetes Reports. In PressGoogle Scholar