Self-Management of Type 1 Diabetes Across Adolescence: A Dissertation

Abstract

Little is known about what variables affect self-management practices of adolescents with T1D. Few studies have examined differences in self-management behaviors by stage of adolescence. Similarly, no studies have examined all of the attributes of self-management, including Collaboration with Parents and Goals. In order to fill the gaps in the literature, a secondary data analysis with a descriptive correlation design was conducted to describe T1D self-management behaviors (Collaboration with Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication and Goals) during early, middle and late stages of adolescence. This study also examined whether the roles of covariates (regimen, duration of illness (DOI), gender) in self-management behaviors vary by stage of adolescence. Data from 504 subjects aged 13 – 21 years were analyzed and the age variable was transformed into three adolescent stages early (13-14) (n=163), middle (15-16) (n=159) and late (17-21) (n=182). The findings revealed significant differences between adolescent stages on Collaboration with Parents and the Diabetes Problem Solving subscale. The covariate analysis showed no significant effect modification for the covariates and stage on any of the subscales so the results did not differ from the ANOVA model. Covariate analysis showed significant associations between regimen and Collaboration with Parents, Diabetes Care Activities and Diabetes Problem Solving. DOI showed significant associations only with Diabetes Problem solving and gender had significant associations with Diabetes Care Activities and Diabetes Communication. The mean scores on Collaboration with Parents show an incremental decline in collaboration with parents as adolescents move through stages. The higher mean Diabetes Problem Solving scores found in the late adolescent group compared correlated with a higher degree of problem solving in this group when compared to those in the early or middle adolescent stage group. Regimen had significant associations with three of the five subscales suggesting this is an important variable for future study. DOI did not have a significant impact on self-management whereas gender related differences in the areas of Diabetes Activities and Diabetes communication warrant further investigation.