1. Necessities for adequate diabetes management
Diabetes acceptance & personal characteristics:
Impact on health & behaviour outcomes in emerging adults with type 1 diabetes
Emma Nieminen & Dr Nuno Ferreira, University of Edinburgh
Objectives: Emerging adulthood is an important transition point for youths with type 1 diabetes. Personal characteristics such as self-efficacy, fear of hypoglycaemia, depressive symptoms, emotional distress, and impulse control have been hypothesized to be key predictors of health and behavioural outcomes1. This study aims to test the utility of incorporating diabetes acceptance2 into this model of transition from adolescence to adulthood, ranging from age 16 to age 25.
Introduction
Diabetes acceptance and sub-clinical depressive symptoms known as diabetes distress predicted 41.7% of variance in self-management (R2 = .417, F(2,142) = 50.83, p < .001).
Diabetes acceptance, diabetes distress, and age of diagnosis predicted 33.7% of variance in glycaemic control (R2 = .337, F(3,134) = 22.69, p < .001).
Diabetes distress was the only predictor of quality of life
(R2 = .502, F(1,143), p < .001).
Acceptance within the Model of Developmental Transition:
* p < 0.05, ** p < 0.01
Results
Diabetes distress is a better indicator than depression in measuring diabetes-related emotional distress and how it relates to outcomes.
Acceptance was highly correlated with other personal characteristic variables, and more importantly, the health and behaviour outcome measures. This provides compelling evidence for it to be incorporated into the Model of Developmental Transition and understanding of the transition process in type 1 diabetes.
Discussion
Diabetes acceptance
Support from loved ones and diabetes healthcare team
Basic living and diabetes needs met
Studies such as this provide empirical evidence that psychosocial problems due to diabetes are barriers to achieving adequate glycaemic control and can interfere with self-management behaviours4.
+ Diabetes acceptance
Transitional Events
Graduating from high school
Leaving parents home
Enrolling in higher education
Joining work force
Transferring to adult healthcare provider
Other life events
Personal Characteristics
Diabetes-specific self-efficacy
Fear of hypoglycaemia
Perceptions about responsibility for diabetes care
Depressive symptoms
Impulse control
Health Outcomes
Diabetes-related Quality of Life
Glycaemic control
Behavioural Outcomes
Diabetes self-management
Healthcare practitioners need to embrace this knowledge in order to best support those with chronic illnesses such as diabetes.
Necessities for adequate diabetes management
Diabetes acceptance is an important predictor of both health and behavioural outcomes in emerging adults with type 1 diabetes. There is also further support for other personal characteristics such as diabetes distress affecting these outcomes. These psychological factors should be integrated into the understanding of physical health and ideal diabetes management within the healthcare sector.
Further research on acceptance in T1D should focus on whether, and to what extent, acceptance-based interventions can impact health and behaviour outcomes in emerging adults5.
Conclusions
Model of Developmental Transition in Emerging Adulthood (Hanna, 2012)
Participants included 177 young adults aged with a diagnosis of T1D recruited from online diabetes support groups. Questionnaires analysed:
Demographic variables: age, sex, ethnicity, education
Diabetes variables: age of diagnosis, treatment type, glycaemic control (HbA1c), diabetes complications, hospitalisation due to diabetes, overall perception of health compared to others the same age
Personal characteristics: Acceptance and Action Diabetes Questionnaire2, Diabetes Distress Scale3, CESD-R, Diabetes Self-Management Questionnaire, Diabetes Empowerment Scale – SF, Hypoglycaemia Fear Survey, Self-regulation Questionnaire (Impulse Control subscale), Diabetes Quality of Life
Linear multiple regression analysis was used to test the predictive value of personal characteristics and acceptance in health (glycaemic control, quality of life) and behavioural (self-management) outcomes.
Methods
Hanna, K. M. (2012). A framework for the youth with type 1 diabetes during the emerging adulthood transition. Nursing Outlook, 60(6),
Schmitt, A., Reimer, A., Kulzer, B., Haak, T., Gahr, A., & Hermanns, N. (2014). Assessment of diabetes acceptance can help identify patients with ineffective diabetes self-care and poor diabetes control. Diabetic Medicine, 31(11),
Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005). Assessing psychosocial distress in diabetes: development of the Diabetes Distress Scale. Diabetes Care, 28(3),
Funnell, M. M. (2006). The Diabetes Attitudes, Wishes, and Needs (DAWN) Study. Clinical Diabetes, 24(4),
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2),
References
Glycaemic control
Self-management
Quality of life
Diabetes distress
Depression
Self-efficacy
Fear of hypos
Impulse control
Acceptance
.37**
-.48**
.46**
.54**
.45**
-.37**
.18*
-.42**
For further information contact Emma Nieminen at