Abstract
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.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Schilling LS, Grey M, Knafl KA. The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis. J Adv Nurs. 2002;37(1):87–99.
SfDiYS Group, Liese AD, D'Agostino Jr RB, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics. 2006;118(4):1510–8.
DCCT. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329(14):977–86.
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.
Silverstein J, Klingensmith G, Copeland K, et al. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care. 2005;28(1):186–212.
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].
Weinger K, Butler HA, Welch GW, La Greca AM. Measuring diabetes self-care: a psychometric analysis of the self-care inventory-revised with adults. Diabetes Care. 2005;28(6):1346–52.
Miller KM, Beck RW, Bergenstal RM, et al. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care. 2013;36(7):2009–14.
White NH, Cleary PA, Dahms W, Goldstein D, Malone J, Tamborlane WV. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr. 2001;139(6):804–12.
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.
Johnson SB, Kelly M, Henretta JC, Cunningham WR, Tomer A, Silverstein JH. A longitudinal analysis of adherence and health status in childhood diabetes. J Pediatr Psychol. 1992;17(5):537–53.
McNabb WL. Adherence in diabetes: can we define it and can we measure it? Diabetes Care. 1997;20(2):215–8.
Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med: J B Diabet Assoc. 2005;22(10):1379–85.
Dashiff CJ, McCaleb A, Cull V. Self-care of young adolescents with type 1 diabetes. J Pediatr Nurs. 2006;21(3):222–32.
Helgeson VS, Siminerio L, Escobar O, Becker D. Predictors of metabolic control among adolescents with diabetes: a 4-year longitudinal study. J Pediatr Psychol. 2009;34(3):254–70.
Craig ME, Handelsman P, Donaghue KC, et al. Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT. Med J Aust. 2002;177(5):235–8.
Bryden KS, Peveler RC, Stein A, Neil A, Mayou RA, Dunger DB. Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study. Diabetes Care. 2001;24(9):1536–40.
Austin S, Senécal C, Guay F, Nouwen A. Effects of gender, age, and diabetes duration on dietary self-care in adolescents with type 1 diabetes: a self-determination theory perspective. J Health Psychol. 2011;16(6):917–28.
Pihoker C, Badaru A, Anderson A, et al. Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study. Diabetes Care. 2013;36(1):27–33.
Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R. Insulin pump therapy: a meta-analysis. Diabetes Care. 2003;26(4):1079–87.
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.
Lawrence JM, Yi-Frazier JP, Black MH, et al. Demographic and clinical correlates of diabetes-related quality of life among youth with type 1 diabetes. J Pediatr. 2012;161(2):201–7.
Skinner TC, John M, Hampson SE. Social support and personal models of diabetes as predictors of self-care and well-being: a longitudinal study of adolescents with diabetes. J Pediatr Psychol. 2000;25(4):257–67.
Bond GG, Aiken LS, Somerville SC. The health belief model and adolescents with insulin-dependent diabetes mellitus. Health Psychol. 1992;11(3):190–8.
Griva K, Myers LB, Newman S. Illness perceptions and self efficacy beliefs in adolescents and young adults with insulin dependent diabetes mellitus. Psychology Health. 2000;15(6):733–50.
Iannotti RJ, Schneider S, Nansel TR, et al. Self-efficacy, outcome expectations, and diabetes self-management in adolescents with type 1 diabetes. J Dev Behav Pediatr: JDBP. 2006;27(2):98–105.
Nouwen A, Urquhart Law G, Hussain S, McGovern S, Napier H. Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes. Psychol Health. 2009;24(9):1071–84.
Jaser SS, Holl MG, Jefferson V, Grey M. Correlates of depressive symptoms in urban youth at risk for type 2 diabetes mellitus. J Sch Health. 2009;79(6):286–92.
Delamater AM, Kurtz SM, Bubb J, White NH, Santiago JV. Stress and coping in relation to metabolic control of adolescents with type 1 diabetes. J Dev Behav Pediatr: JDBP. 1987;8(3):136–40.
Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. J Consult Clin Psychol. 2007;75(2):336.
Gallant MP. The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav. 2003;30(2):170–95.
Skinner TC, Hampson SE. Social support and personal models of diabetes in relation to self-care and well-being in adolescents with type I diabetes mellitus. J Adolesc. 1998;21(6):703–15.
Barrera Jr M, Glasgow RE, Mckay HG, Boles SM, Feil EG. Do Internet-based support interventions change perceptions of social support?: An experimental trial of approaches for supporting diabetes self-management. Am J Community Psychol. 2002;30(5):637–54.
La Greca AM, Auslander WF, Greco P, Spetter D, Fisher Jr EB, Santiago JV. I get by with a little help from my family and friends: adolescents' support for diabetes care. J Pediatr Psychol. 1995;20(4):449–76.
Gleeson–Kreig J, Bernal H, Woolley S. The role of social support in the self–management of diabetes mellitus among a Hispanic population. Publ Health Nurs. 2002;19(3):215–22.
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.
Berlin KS, Rabideau EM, Hains AA. Empirically derived patterns of perceived stress among youth with type 1 diabetes and relationships to metabolic control. J Pediatr Psychol. 2012;37(9):990–8.
Hood KK, Huestis S, Maher A, Butler D, Volkening L, Laffel LM. Depressive symptoms in children and adolescents with type 1 diabetes: association with diabetes-specific characteristics. Diabetes Care. 2006;29(6):1389–91.
Lawrence JM, Standiford DA, Loots B, et al. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth Study. Pediatrics. 2006;117(4):1348–58.
Kovacs M, Obrosky DS, Goldston D, Drash A. Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome. Diabetes Care. 1997;20(1):45–51.
Grey M, Whittemore R, Tamborlane W. Depression in type 1 diabetes in children: natural history and correlates. J Psychosom Res. 2002;53(4):907–11.
McGrady ME, Laffel L, Drotar D, Repaske D, Hood KK. Depressive symptoms and glycemic control in adolescents with type 1 diabetes: mediational role of blood glucose monitoring. Diabetes Care. 2009;32(5):804–6.
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.
Grey M, Boland EA, Davidson M, Li J, Tamborlane WV. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr. 2000;137(1):107–13.
Kahana S, Drotar D, Frazier T. Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions. J Pediatr Psychol. 2008;33(6):590–611.
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.
American Diabetes A. Standards of medical care in diabetes–2011. Diabetes Care. 2011;34 Suppl 1:S11–61.
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.
Weissberg-Benchell J, Glasgow AM, Tynan WD, Wirtz P, Turek J, Ward J. Adolescent diabetes management and mismanagement. Diabetes Care. 1995;18(1):77–82.
Mortensen HB, Robertson KJ, Aanstoot HJ, et al. Insulin management and metabolic control of type 1 diabetes mellitus in childhood and adolescence in 18 countries. Hvidore study group on childhood diabetes. Diabet Med: J B Diabet Assoc. 1998;15(9):752–9.
Hamilton J, Daneman D. Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab: JPEM. 2002;15(2):115–26.
Helgeson VS, Reynolds KA, Siminerio L, Escobar O, Becker D. Parent and adolescent distribution of responsibility for diabetes self-care: links to health outcomes. J Pediatr Psychol. 2008;33(5):497–508.
Wysocki T, Nansel TR, Holmbeck GN, et al. Collaborative involvement of primary and secondary caregivers: associations with youths' diabetes outcomes. J Pediatr Psychol. 2009;34(8):869–81.
Berg CA, Butler JM, Osborn P, et al. Role of parental monitoring in understanding the benefits of parental acceptance on adolescent adherence and metabolic control of type 1 diabetes. Diabetes Care. 2008;31(4):678–83.
Jaser SS. Family interaction in pediatric diabetes. Curr Diabetes Rep. 2011;11(6):480–5.
Ingerski LM, Anderson BJ, Dolan LM, Hood KK. Blood glucose monitoring and glycemic control in adolescence: contribution of diabetes-specific responsibility and family conflict. J Adolesc Health. 2010;47(2):191–7.
Ellis DA, Podolski C-L, Frey M, Naar-King S, Wang B, Moltz K. The role of parental monitoring in adolescent health outcomes: impact on regimen adherence in youth with type 1 diabetes. J Pediatr Psychol. 2007;32(8):907–17.
Anderson BJ, Holmbeck G, Iannotti RJ, et al. Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes. Fam, Syst Health: J Collab Fam Healthcare. 2009;27(2):141–52.
Anderson BJ, Vangsness L, Connell A, Butler D, Goebel-Fabbri A, Laffel LM. Family conflict, adherence, and glycaemic control in youth with short duration type 1 diabetes. Diabet Med: J Br Diabet Assoc. 2002;19(8):635–42.
Wiebe DJ, Berg CA, Korbel C, et al. Children's appraisals of maternal involvement in coping with diabetes: enhancing our understanding of adherence, metabolic control, and quality of life across adolescence. J Pediatr Psychol. 2005;30(2):167–78.
Modi AC, Pai AL, Hommel KA, et al. Pediatric self-management: a framework for research, practice, and policy. Pediatrics. 2012;129(2):e473–85.
Grey M. Interventions for children with diabetes and their families. Ann Rev Nurs Res. 2000;18:149–70.
Wysocki T, Harris MA, Buckloh LM, et al. Randomized, controlled trial of behavioral family systems therapy for diabetes: maintenance and generalization of effects on parent-adolescent communication. Behav Ther. 2008;39(1):33–46.
Laffel LMB, Vangsness L, Connell A, Goebel-Fabbri A, Butler D, Anderson BJ. Impact of ambulatory, family-focused teamwork intervention on glycemic control in youth with type 1 diabetes. J Pediatr. 2003;142(4):409–16.
Bindman AB, Grumbach K, Osmond D, et al. Preventable hospitalizations and access to health care. JAMA, J Am Med Assoc. 1995;274(4):305–11.
Gill JM, Mainous 3rd AG. The role of provider continuity in preventing hospitalizations. Arch Fam Med. 1998;7(4):352–7.
Rewers A, Chase H, Mackenzie T, et al. Predictors of acute complications in children with type 1 diabetes. JAMA, J Am Med Assoc. 2002;287(19):2511–8.
Certification CfCM. 2005.
Welch G, Garb J, Zagarins S, Lendel I, Gabbay RA. Nurse diabetes case management interventions and blood glucose control: results of a meta-analysis. Diabet Res Clin Pract. 2010;88(1):1–6.
Joo JY, Huber DL. An integrative review of case management for diabetes. Prof Case Manag. 2012;17(2):72–85.
Harris MA, Wagner DV, Heywood M, Hoehn D, Bahia H, Spiro K. Youth repeatedly hospitalized for DKA: proof of concept for novel interventions in children’s healthcare (NICH). Diabetes Care. 2014;37(6):e125–6.
Wysocki T, Harris MA, Buckloh LM, et al. Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents. Diabetes Care. 2007;30(3):555–60.
Madden M, Lenhart A, Duggan M, Cortesi S, Gasser U. Teens and Technology 2013: Pew Research Center; 2013
Liang X, Wang Q, Yang X, et al. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med. 2011;28(4):455–63.
Mulvaney SA, Ritterband L, Bosslet L. Mobile intervention design in diabetes: review and recommendations. Curr Diabet Rep. 2011;11:486–93.
Chomutare T, Fernandez-Luque L, Årsand E, Hartvigsen G. Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res. 2011;13(3):e65.
Kumah-Crystal Y, Mulvaney SA. Utilization of blood glucose data in patient education. Current Diabetes Reports. In Press
Mulvaney SA, Anders S, Smith AK, Pittel EJ, Johnson KB. A pilot test of a tailored mobile and web-based diabetes messaging system for adolescents. J Telemed Telecare. 2012;18:115–8.
Hanauer DA, Wentzell K, Laffel N, Laffel LM. Computerized automated reminder diabetes system (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management. Diabetes Technol Ther. 2009;11(2):99–106.
Franklin VL, Waller A, Pagliari C, Greene SA. A randomized controlled trial of sweet talk, a text-messaging system to support young people with diabetes. Diabet Med. 2006;23(12):1332–8.
Mulvaney SA, Rothman RL, Wallston KA, Lybarger C, Dietrich MS. An internet-based program to improve self-management in adolescents with type 1 diabetes. Diabetes Care. 2010;33(3):602–4.
Whittemore R, Jaser SS, Jeon S, et al. An internet coping skills training program for youth with type 1 diabetes. Nurs Res. 2012;61(6):395–404.
Landau Z, Mazor-Aronovitch K, Boaz M, et al. The effectiveness of Internet-based blood glucose monitoring system on improving diabetes control in adolescents with type 1 diabetes. Pediatr Diabetes. 2012;13(2):203–7.
Winkley K, Landau S, Eisler I, Ismail K. Psychological interventions to improve glycaemic control in patients with type 1 diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ. 2006;333(7558):65.
Compliance with Ethics Guidelines
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Psychosocial Aspects
Rights and permissions
About this article
Cite this article
Naranjo, D., Mulvaney, S., McGrath, M. et al. Predictors of Self-Management in Pediatric Type 1 Diabetes: Individual, Family, Systemic, and Technologic Influences. Curr Diab Rep 14, 544 (2014). https://doi.org/10.1007/s11892-014-0544-7
Published:
DOI: https://doi.org/10.1007/s11892-014-0544-7