Transition to self-management among emerging adults with type 1 diabetes: a mixed methods study

R. Vitale, Noa Asher, Kaitlyn Shank, Biren Katyal, Liane J. Tinsley, Katharine C. Garvey, Lori M. B. Laffel
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Abstract

Emerging adulthood is challenging for young people with type 1 diabetes (T1D). This study evaluated transition to diabetes self-management and perceptions of care transfer using mixed methods.An online survey queried demographics, management characteristics, diabetes knowledge, self-care readiness, adherence, and diabetes distress. T-tests compared survey scores between those with self-reported target A1c <7.0% versus ≥7.0%. Pearson correlations assessed associations between A1c and diabetes distress, stratified by A1c <7.0% versus ≥7.0%. Qualitative semi-structured interviews elicited perceptions of young adults; transcripts were analyzed using directed qualitative content analysis.Of 141 participants (30% male, 84% non-Hispanic white) completing the survey, 41% self-reported target A1c <7.0%. Diabetes knowledge and self-care readiness scores did not differ between those with A1c <7.0% versus ≥7.0%, while diabetes distress was lower (45 ± 20 vs 52 ± 20, p=0.01) and adherence higher (77 ± 12 vs 71 ± 14, p=0.02) in those with A1c <7.0% versus ≥7.0%. Diabetes distress was significantly associated with glycemic outcomes in those reporting A1c ≥7.0% (R=0.36, p<0.01). Qualitative analysis (24 participants) revealed five themes and two sub-themes, notable for need for more mental health support, support from others with T1D, benefits of technology for care autonomy, and challenges of obtaining diabetes supplies.Emerging adults with self-reported target A1c endorsed lower diabetes distress and higher adherence than those with elevated A1c. Mental health access, support from others with T1D, technology use, and guidance for supply acquisition may improve transition to self-management and care transfer for emerging adults with T1D.
1 型糖尿病新成人患者向自我管理的过渡:一项混合方法研究
对于患有 1 型糖尿病(T1D)的年轻人来说,步入成年是一项挑战。这项研究采用混合方法评估了向糖尿病自我管理过渡的情况以及对护理转移的看法。在线调查询问了人口统计学、管理特征、糖尿病知识、自我护理准备情况、依从性和糖尿病困扰。通过 T 检验比较了自我报告目标 A1c <7.0% 与 ≥7.0% 的调查得分。根据 A1c <7.0% 与 ≥7.0% 的分层,Pearson 相关性评估了 A1c 与糖尿病困扰之间的关联。半结构式定性访谈征求了年轻人的看法;采用定向定性内容分析法对访谈记录进行了分析。在完成调查的 141 名参与者(30% 为男性,84% 为非西班牙裔白人)中,41% 的人自我报告目标 A1c <7.0%。A1c<7.0%与≥7.0%的参与者在糖尿病知识和自我保健准备得分方面没有差异,而A1c<7.0%与≥7.0%的参与者在糖尿病困扰方面的得分较低(45 ± 20 vs 52 ± 20,p=0.01),坚持治疗的得分较高(77 ± 12 vs 71 ± 14,p=0.02)。在报告 A1c≥7.0% 的人群中,糖尿病困扰与血糖结果明显相关(R=0.36,p<0.01)。定性分析(24 名参与者)揭示了五个主题和两个次主题,其中值得注意的是需要更多的心理健康支持、来自其他 T1D 患者的支持、技术对护理自主性的益处以及获得糖尿病用品的挑战。对患有 T1D 的新成人来说,心理健康的获取、来自其他 T1D 患者的支持、技术的使用以及获取用品的指导可以改善他们向自我管理和护理转移的过渡。
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