Perceptions of Diabetes Self-Efficacy and Glycemic Control in Youth With Type 1 Diabetes.

Abstract

Type 1 diabetes is a chronic disease affecting ∼3 million Americans (1). The disease is characterized by autoimmune destruction of insulin-producing cells; affected individuals depend on insulin therapy for survival. Although type 1 diabetes is the third most common chronic disease in childhood, 85% of individuals with type 1 diabetes are adults (2). Optimal management of type 1 diabetes comes at the expense of heavy burden for those with the disease. Although major advances have been made both in the pharmacology of insulin analogs and technological tools to assist in glucose management, only 21% of individuals with type 1 diabetes are able to meet their glycemic targets (3). These struggles are more apparent during adolescence and young adulthood, a developmental period during which adherence levels are low and glycemic control is poorest. In fact, only 17% of youth achieve glycemic targets (3). Type 1 diabetes increases morbidity and mortality from microvascular and macrovascular disease. The Diabetes Control and Complications Trial and its Epidemiology of Diabetes Interventions and Complications follow-up study examined the effect of intensive blood glucose control on the risk of future complications in patients >13 years of age with type 1 diabetes. These studies demonstrated that intensive blood glucose control profoundly reduces the risk of future microvascular complications (4–6). Despite the many technological advances during the past several years, A1C has worsened rather than improving in the adolescent years, and the period from late adolescence through early adulthood remains a challenging time for youth with type 1 diabetes. The unrelenting day-to-day management of type 1 diabetes becomes particularly difficult (7) at this time of many transitions, as these emerging adults make important decisions about their education, career, and health care. Some move away from their home support to attend college, whereas others face …