ABSTRACT
AIMS: The current study was designed to identify barriers that prevent young adults with DM1 from achieving glycemic control. METHODS: Eighty-three young adult patients with DM1 [age 22.2 ± 2.8 years (mean ± SD), duration diabetes 11.3 ± 5.6 years, HbA1c 8.8 ± 2.1%] completed a battery of surveys assessing potential barriers to achieving glycemic control. Results of questionnaires were correlated with the patient's most recent HbA1c, and a multiple regression analysis was conducted to determine what barriers were significantly associated with HbA1c levels. RESULTS: Questionnaires that significantly correlated with HbA1c levels included the Conflict Subscale of the Diabetes Responsibility and Conflict Scale (r = .55, p < .01), the Modified Barriers to Adherence Questionnaire (r = .42, p < .01), and the Hospital Anxiety and Depression Scale (r = .31, p < .05). An item analysis of the Modified Barriers to Adherence Scale suggested that patient confidence with carbohydrate counting was most statistically associated with HbA1c [F(3, 80) = 12.95, p < .01, R²=.35]. CONCLUSIONS: Results suggest that despite attempts to educate patients; barriers such as family conflict, psychological issues, and carbohydrate counting remain obstacles impeding glycemic control in young adults with DM1.
Subject(s)
Diabetes Mellitus, Type 1/therapy , Patient Compliance , Adult , Blood Glucose/metabolism , Cross-Sectional Studies , Dietary Carbohydrates/administration & dosage , Female , Glycated Hemoglobin/analysis , Humans , Insulin Infusion Systems , Life Style , Male , Patient Education as Topic , Regression Analysis , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: To evaluate the effect of specialized young adult diabetes clinic (YAC) on glycemic control in a young adult patients with type 1 diabetes (DM1) transitioning from pediatric to adult diabetes care. RESEARCH DESIGN AND METHODS: HbA1c was retrospectively analyzed through 3 years in 15-25 y/o DM1 patients entering a YAC, and compared to similar patients entering general endocrine clinics (GEC) in a university diabetes center. RESULTS: Ninety-six patients were seen in the YAC, compared to 153 patients in the GEC. No difference in HbA1c was seen at entry (YAC 9.0+/-2.3% versus 8.8+/-2.3%). HbA1c did not change over time in either clinic (mean 3-year HbA1c 8.6+/-2.1% in YAC versus 8.4+/-2.3% in GEC). When the HbA1c values were divided into tertiles, no differences in distribution of baseline HbA1c were seen. Within the highest tertile, the YAC had a greater fall in HbA1c, compared to the GEC. Pump users from both clinics had HbA1c values 1% lower at each time point. CONCLUSIONS: Young adults with DM1 continue to have difficulty achieving target HbA1c values. Earlier use of pump therapy and a specialized YAC for those with the worst glycemic control will benefit this population.
