Early risk factors for nonadherence in pediatric type 1 diabetes: a review of the recent literature.
Nonadherence to different aspects of the diabetes regimen is common. Problems early in the course of illness predict later difficulties with nonadherence; conversely, good management early on protects against later complications. Screening for early risk factors at the time of diabetes diagnosis is therefore critical for promoting the health of children with type 1 diabetes. The purpose of this paper is to review and synthesize the recent empirical literature on early risk factors for nonadherence in type 1 diabetes, with a focus on three specific adherence behaviors: insulin administration, blood glucose monitoring, and clinic attendance. Risk factors are considered within several broad categories: sociodemographic barriers that limit access to care; child and parent factors that affect adherence both directly and indirectly via their impact on the development of family teamwork; and family interactions with their health-care providers. We integrate the different findings into a "simple model" that can be used to develop efficient screening protocols that can in turn guide efforts at preventive intervention.
Schwartz
David D
DD
Department of Pediatrics, Divisions of Psychology and Endocrine-Metabolism, Baylor College of Medicine/Texas Children's Hospital, Houston, TX 77030-2399, USA. ddschwar@bcm.edu
Cline
Virginia Depp
VD
Hansen
J A
JA
Axelrad
Marni E
ME
Anderson
Barbara J
BJ
D015190:Blood Glucose Self-Monitoring; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000523:psychology*; D005195:Family Relations; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D010349:Patient Compliance / Q000523:psychology*; D012307:Risk Factors; D012959:Socioeconomic Factors
D007004:Hypoglycemic Agents; D007328:Insulin