Study Seeks Ways to Help Young Diabetics Help Themselves
A National Institutes of Health grant will fund research at UT Dallas and UT Southwestern Medical Center for a new study of diabetes management and the factors affecting young people’s ability to follow recommended treatments.
Dr. Deborah Wiebe
Dr. Deborah Wiebe, who holds joint appointments in UT Dallas’ School of Behavioral and Brain Sciences and UT Southwestern, is one of two principal investigators for the study. The NIH grant, which totals $2.7 million and runs through 2016, will fund research activities across multiple sites, including UT Southwestern and UT Dallas. The grant was awarded to the University of Utah and UT Southwestern.
Previous studies showed older adolescents and young adults face major challenges following a diabetes regimen, which leads to increased risk for serious long-term health complications, including death. But this research team also has found that parental monitoring is beneficial for maintaining adherence through adolescence by bolstering the young person’s own self-regulatory skills, such as maintaining diabetes goals, preventing problems from occurring and adjusting to problems when they do occur.
The new project will examine whether still-developing mental abilities limit late adolescents’ ability to regulate diabetes problems and follow the regimen. About 250 adolescents with Type 1 diabetes will be recruited from Texas and Utah during their senior years of high school and assessed annually for three years.
Researchers and students from UT Dallas and UT Southwestern will collaborate on the Dallas effort. Dr. Cynthia Berg of the University of Utah is the other principal investigator for the study.
“During emerging adulthood – ages 18 to 25 – diabetes management is difficult,” Wiebe said. “Youth are transitioning out of the parental home, often moving to new locations or living on their own for the first time, as well as transitioning from pediatric medical care to adult care. Meanwhile, the cognitive control processes that promote good decision-making and self-regulation continue to develop well into our 20s. So at the same time emerging adults are facing many transitions, they are still developing the neurocognitive skills necessary to meet all of these challenges.”
“We are finding that many of the family and developmental factors that are important for type 1 diabetes are also important for other illnesses, including asthma, spina bifida, etc.”
Dr. Deborah Wiebe
Wiebe and her team will use behavior tests and self-reports to identify which neurocognitive abilities (executive function, impulse control and attention control) are needed to maintain adherence during the transition period. The researchers also will determine how the abilities relate to daily self-regulation by having students track their progress in diaries.
The final aim of the study involves examining whether parental monitoring across the transition to emerging adulthood benefits young people with low mental abilities.
Parents’ involvement in diabetes management has to start with good communication, making their children feel comfortable disclosing problems, Wiebe said. Beyond that, parents should continue to stay aware of their children’s activities, but they also have to respect the adolescents’ need for some degree of autonomy.
The findings could yield important data regarding effective ways to tailor family involvement in medical treatment.
“We are finding that many of the family and developmental factors that are important for Type 1 diabetes are also important for other illnesses, including asthma, spina bifida, etc.,” she said. “It’s even possible that the findings are applicable to the general population, not just those with a chronic condition. For example, parental factors that are important for helping teens and young adults manage diabetes turn out to be important for many other things as well, such as academic achievement and lower delinquency.”
The manner in which adolescents and young adults manage their diabetes can set the stage for how well their illness is managed into adulthood, and can influence how rapidly they develop complications of having diabetes. These complications can include the risk for blindness, limb amputations, heart disease and stroke.
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