Predictors of Adherence, Metabolic Control and Quality of Life in Adolescents with Type 1 Diabetes

Abstract

Diabetes Mellitus Type I (DM1) is a diagnosed disease that appears before age 35 (Hanas, 2007) and is well known, in the pediatric population, as one of the most common diseases (Serafino, 1990). The diagnosis occurs mostly in childhood and adolescence, often between ages 5 and 11 (Eiser, 1990). The definition of adolescence is a bit controversial but OMS (1965) establishes adolescence between 10 and 19 years old. The beginning of adolescence starts with the appearance of the first biological changes of puberty. According to Erikson’s theory of psychosocial development (Erikson, 1968), the central task of adolescence is the development of autonomy, identity and self integration (Barros, 2003). In fact, identity formation, in adolescence, requires a reorganization of capacities, desires, needs and interests in the adolescent, as well as a quest for more independence towards parents. Nevertheless, the difficulties, even in the well succeeded resolution of the psychosocial tasks, may result in “identity confusion” (Erikson, 1968). In adolescents with diabetes, the disease can be an additional stressor functioning as another factor that requires acceptation and self integration. Diabetes exposes adolescents to potentially unpleasant experiences (having to explain others about the disease, medical exams, etc.) that can limit or prevent normal development and life experiences in adolescence (Close et al., 1986). On the other hand, physiological and hormonal changes that take place in adolescence may increase insulin resistance contributing to a weak control of diabetes (Duarte, 2002). In short, adolescence is a developmental phase, marked by changes and identity formation ,that requires a permanent and dynamic adaptation of the adolescent, ranging from feelings of acceptation to anger/anxiety and even depression (Leite, 2005) that can affect adherence to therapy and adaptation to illness. It is important to keep in mind that being adolescent is more important than being diabetic (Burroughs et al., 1997).