**7. References**

132 Type 1 Diabetes – Complications, Pathogenesis, and Alternative Treatments

adolescent's life may be associated to more parental support regarding diabetes'

In terms of predictors of metabolic control, higher adherence to diabetes self-care predicted better metabolic control (lower levels of glycated hemoglobin). In fact, higher adherence to diabetes self-care has been found to predict good metabolic control in adolescents with type 1 diabetes, and lower quality of life, on the other hand, to predict poor metabolic control (Lewin et al., 2009). Higher levels of glycated hemoglobin have been associated to more worries regarding diabetes having, therefore, a negative impact on quality of life

Parents' understanding of the medical situation (coping with diabetes) predicted lower levels of glycated hemoglobin (better metabolic control) in the adolescent. This is a very interesting result. Family environment is important in the complex mechanism of adaptation to diabetes self-care having also an impact on metabolic control (Grey & Berry, 2004). In a study about behavioral therapy with families of adolescents with diabetes, when the relationship between parents and adolescents with diabetes improved, parents´ coping with their adolescents' diabetes got better producing also better outcomes, such as good

Adolescent's emotional representation of diabetes (as a threatening disease) predicted higher levels of glycated haemoglobin (poor metabolic control). In a study about health beliefs in adolescents with type 1 diabetes, negative illness perception, like illness severity and susceptibility were predictors of poor metabolic control. On the other hand, lower family's comprehension (illness coherence) of diabetes predicted bad metabolic control in the adolescent. This result emphasizes the importance of parents' understanding of the impact of diabetes on their child suggesting that those parents who understand less the disease may exercise less parental supervision and provide less family support regarding

In terms of quality of life, higher school support predicted higher quality of life. This result is in accordance with the literature. Peers relationships are paramount on the psychological well-being of adolescents with diabetes (Helgeson et al., 2009). In fact, relationships with peers can positively or negatively (e.g. conflict experiences) influence quality of life of adolescents with type 1 diabetes. Adolescents who have more positive attitudes with their school experience tended to experience lower problems and worries with diabetes's

Lower quality of life was predicted by higher perceptions of diabetes consequences and higher perceptions of emotional representation (more threatening). This result is in accordance with the literature. In fact, using the same illness perceptions questionnaire, with adults with type 2 diabetes, lower quality of life was found to be related to stronger beliefs of diabetes consequences and negative emotional representations (Edgar et al., 2003). Also, in another study, illness beliefs predicted quality of life i.e. consequences and emotional representations of diabetes were found to predict low quality of life in adolescents

In this study, the importance of family factors (family support and parental coping) become evident on diabetes outcomes. As a result, it is important to include parents on intervention programs regarding diabetes in adolescence, School support is also an important factor and

diabetes's management and, as a consequence, metabolic control decreases.

management tasks in order to decrease future complications in the adolescent.

(Guttmann-Bauman et al., 1998).

metabolic control in the adolescent (Wysocki et al., 2000).

management (Lehmkuhl & Nabors, 2007).

(Paddison et al., 2008).

**6. Conclusion** 


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**8** 

*USA* 

**Contributing Factors to Poor Adherence and** 

**Facilitating a Move Toward Telehealth** 

*2University of Florida, Department of Clinical and Health Psychology* 

*3University of Florida, Department of Counselor Education* 

 Sarah E. Righi1 and Gary R. Geffken1 *1University of Florida, Department of Psychiatry* 

Joseph P. H. McNamara1, Adam M. Reid2, Alana R. Freedland3,

**Glycemic Control in Pediatric Type 1 Diabetes:** 

The study of family's with children with T1D and their regimens has led to a burgeoning literature by psychologist's with an interest in the relationship between adherence and glycemic control. Research in pediatric or child health psychology may be described as focusing on studying behavioral health, or psychological factors including learning, development, psychopathology, and culture as they interact with biological and physiological factors involved with illness, and in many cases, chronic illnesses. T1D is a chronic illness where an increasingly complex medical regimen for the child's illness interacts with the child's family, their school, their peers, and their culture. T1D is a chronic illness where the research of child health psychologists and other health care professionals can be seen as providing a prototype or model of other chronic illness of childhood that have a lower prevalence, and hence have a literature that is comparatively less developed

Type 1 Diabetes (T1D) is a complex and challenging disease for children and adolescents due to the necessary integration of daily medical tasks (e.g., blood glucose monitoring) and lifestyle modifications. Evidence suggests that a substantial percentage of children are nonadherent to these demands.[1,2] Although some of those who are non-adherent experience few negative consequences, a large number of non-adherent children are at risk for significant medical complications including diabetic ketoacidosis (DKA), neuropathy, nephropathy, retinopathy, and cardiovascular disease.[3] Despite improvements in fluid and insulin therapy, fatality rates are still estimated at 1 to 2% of youth who experience a DKA episode. Non-adherence can also negatively impact clinical decisions made by health care providers such as prescribing incorrect insulin doses. Further, poor adherence results in increased morbidity and mortality, as well as problematic medication use and excessive use of health care services.[4,5] Numerous factors have a significant impact on adherence and

**1. Introduction** 

than that of T1D.

glycemic control.

**2. The challenges of type 1 diabetes** 

