A review of adolescent adherence in type 1 diabetes and the untapped potential of diabetes providers to improve outcomes

Abstract

Only 21 % of adolescents with type 1 diabetes (T1D) meet glycemic goals set forth by the American Diabetes Association. Adherence to therapy is a particular concern in this population, and the association between poor adherence and worsening glycemic control indicates that there is a critical need to improve adherence to therapy in adolescents with T1D. In this article, we review barriers to adherence in adolescents with T1D and discuss interventions aimed at improving adherence to therapy and glycemic control. Interventions include technology-based applications, family-based therapies, motivational interviewing, and others. Notably, less than 10 % of the interventions reviewed are provider-led, clinic-based interventions, and few have focused on regimen-related aspects of adherence. This article also outlines the importance of provider communication and the role of providers in facilitating adherence behaviors in adolescents with T1D. Finally, we suggest future directions of research to improve adherence to therapy in adolescents with T1D.

Fig. 1

Intervention studies (n=32) in youth with diabetes that have components to improve adherence in the intervention- and/or adherence-based outcome measures, separated by who delivered the intervention. A minority of recent intervention studies with adherence-based components in adolescents with diabetes are performed by providers. A automated [, , –53]; R research staff [, , , –57]; N nurse, diabetes educator, social worker, and dietician [–65]; P PhD-trained psychologist, graduate student therapist, and therapist [, , , , , , –67]; PR provider (nurse practitioner or physician) [33, 36, 51, 64]; U unable to determine who provided the intervention [–71]