Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention

Abstract

Purpose of review: Despite the availability of effective therapies, adolescents with type 1 diabetes demonstrate poorer adherence to treatment regimens compared with other pediatric age groups. Nonadherence is tightly linked to suboptimal glycemic control, increasing morbidity, and risk for premature mortality. This article will review barriers to adherence and discuss interventions that have shown promise in improving outcomes for this population.

Recent findings: Adolescents face numerous obstacles to adherence, including developmental behaviors, flux in family dynamics, and perceived social pressures, which compound the relative insulin resistance brought on by pubertal physiology. Some successful interventions have relied on encouraging nonjudgmental family support in the daily tasks of blood glucose monitoring and insulin administration. Other interventions overcome these barriers through the use of motivational interviewing and problem-solving techniques, flexibility in dietary recommendations, and extending provider outreach and support with technology.

Summary: Effective interventions build on teens' internal and external supports (family, technology, and internal motivation) in order to simplify their management of diabetes and provide opportunities for the teens to share the burdens of care. Although such strategies help to minimize the demands placed upon teens with diabetes, suboptimal glycemic control will likely persist for the majority of adolescents until technological breakthroughs allow for automated insulin delivery in closed loop systems.

Figure 1. Constellation of factors that influence treatment adherence in adolescents with type 1 diabetes

Although adherence directly influences glycemic control measured as HbA1c, there is a constellation of factors that impacts adherence in adolescents with type 1 diabetes. These include unmodifiable factors such as age and duration of diabetes and modifiable factors such as diabetes-specific family conflict, family involvement, and implementation of technologies for diabetes management. The overall aim is to achieve target glycemic control with HbA1c values of less than 7.5% for teens with diabetes in order to preserve health and prevent long-term complications of the disease. HbA1c, hemoglobin A1c.