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


RESULTS
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.


CONCLUSIONS
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.
Borus
Joshua S
JS
Division of Adolescent/Young Adult Medicine, Department of Medicine, Children's Hospital Boston, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02115, USA. joshua.borus@childrens.harvard.edu
Laffel
Lori
L
D000293:Adolescent; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D014481:United States / Q000453:epidemiology
D007004:Hypoglycemic Agents