**1. Introduction**

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444 Type 1 Diabetes

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Diabetes Mellitus is a globe and a growing serious public health problem. Type 1 Diabetes is estimated to be one of the five most prevalent chronic diseases in children and adolescents, corresponding to 5-10% of all cases worldwide [1, 2]. Type 1 diabetes is an autoimmune chronic disease resulting from total absence of insulin secretion. In order to replace the ab‐ sence of insulin production by the cells in the islets of Langerhans, located in the pancreas, it is necessary to administer exogenous insulin [3-5].

Nutrition and physical exercise also play fundamental roles in managing type 1 diabetes, in association with insulin therapy. The nutrition of an adolescent with diabetes should be guided by the principles of healthy eating and by the regular practice of physical exercise, in order to facilitate the control of blood glucose levels, prevent associated complications, maintain body weight within the normal standards and reduce cardiovascular diseases risk factors, providing psychosocial and familiar well-being [6-9]. However, diet and physical ac‐ tivity are the type of self-care activities that adolescents with diabetes are less concerned with [10].

Type 1 diabetes has a multifactorial etiology, in which genetic factors are important, due to modifications in the HLA complex (Human Leukocite Antigen Complex), behavioral fac‐ tors, which can include viral infections (enteroviruses, coxsackie virus, congenital rubella) and environmental borne toxins, such as nitrosamines or even food such as the early expo‐ sure to cow's milk proteins, cereals or gluten, and in this case, the antibodies produced by

© 2013 Almeida et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

the immune system's T cells to destroy these potentially invading agents also act on the pan‐ creas β cells, destroying them [11-13].

**2. Adherence to self-care in the adolescent with type 1 diabetes**

control and the promotion of quality of life [36-38].

the type of disease or its severity [41].

ment and 5) factors related to the patient.

The diagnosis of a chronic condition such as diabetes involves a change in lifestyle as well as the use of therapeutic methods that, at times, adolescents may not have the will or capacity to integrate into their daily lives resulting in risks to their health [32-35]. Considering that the prescribed treatment regimen can be complex, the role of health professionals involved with patient's care is of crucial relevance and intervention should emphasize symptoms'

The Influence of Family Support, Parental Coping and School Support on Adherence to Type 1 Diabetes' Self-Care in

Adolescents

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http://dx.doi.org/10.5772/53062

There are strong evidences that individuals with chronic diseases, such as diabetes, present difficulties in adhering to the prescribed therapeutic regimes, with the consequent complexi‐ ties of managing and controlling the disease [39, 40]. However, the literature shows that some adolescents have problems in adhering to a self-administrate treatment regardless of

Non-adherence to treatment of a chronic disease, particularly in type 1 diabetes, embodies a problem of multifactorial etiology and indeed different attempts to explain adherence be‐ havior to prescribed treatments have been proposed [32]. According to the World Health Organization [41], different factors affecting adherence can be classified into five groups: 1) social, economic and cultural factors; 2) factors related to the health services and professio‐ nals; 3) factors underlying the disease and the comorbidity; 4) factors related to the treat‐

Adolescents with diabetes, in particular, go through a phase of strong psychosocial changes and have to deal simultaneously with the changes of adolescence itself and as well as coping with the demands of controlling the disease treatment specificities [16, 42-45]. The hormonal changes occurring during puberty that cause insulin resistance, the rebelliousness character‐ istic of this phase, and almost total absence of residual insulin secretion by the pancreas,

The stigma associated with chronic disease, the need for self-care in social contexts and the risk of hypoglycemia, reinforces the idea that adolescents with diabetes are different from their colleagues and friends, which can lead to a feeling of inferiority and negatively influ‐ ence adherence to self-care behaviors outside their family and personal context [46, 48, 49]. Since adolescence corresponds to the transition between childhood and adulthood, both families and health professionals encourage and stimulate the independence of these young‐ sters regarding the management of their diabetes [46, 48, 49]. However, this rapid transition can lead to personal and family conflicts, probably because the adolescent has not devel‐ oped the necessary maturity to assume this type of responsibility [16]. In fact, management of diabetes can be considered a major challenge for adolescents, worsened by physical and hormonal changes, characteristic of this developmental phase which may lead to frequent changes in the therapeutic regimen [50]. Living with a chronic disease, during adolescence is hard and the adolescent may experience more difficulties in adapting to diabetes [2, 17]. Very often, adolescents with diabetes mention their frustration, stress and anxiety, with a lack of motivation regarding the management of the disease, which may negatively influ‐

may complicate diabetes treatment, particularly, adherence [15, 46, 47].

Self-management and self-care is of critical importance for the control of this type of diabe‐ tes in children and adolescents. In fact, the responsibility of regularly monitoring the disease and its symptoms and the compliance with the treatment lies with the family and later, in accordance with the growth and the development phase, are gradually transferred to the child/adolescent [14-17]. Therefore, the main goals for type 1 Diabetes Mellitus's treatment, in children and adolescents, emphasize the prevention of symptoms and their severity, the prevention of short and long term complications, and the appropriate growth and develop‐ ment of the adolescent allowing the suitable maintenance of daily activities such as those re‐ lated to family dynamics, school and social life [15, 18-20].

However, the multiple physiological and psychosocial modifications occurring during ado‐ lescence compromise diabetes treatments during this developmental period [15, 21, 22] and often, the adolescent show serious difficulties in adhering to self-care management of diabe‐ tes and the prevention of its complications. The conflicts arising from the demands and com‐ plexities involved in the self-management of diabetes, and the adolescent's expectations regarding their own experiences, in this developmental phase, may account for this scenario [23, 24].

According to the World Health Organization (WHO), adolescence is placed between 10-19 years, during which the individual is subjected to changes of biological nature, determined by puberty that will produce a rapid growth with consequently distinct body transforma‐ tions; changes of cognitive nature, with a higher complexity in reasoning skills, through the attainment of autonomy and identity construction and also changes of social nature with the experience of new and different roles [25-27]. However, the constant need to declare autono‐ my and independence leads the adolescent to idealize feelings of invulnerability, inconsis‐ tent with the acceptance of a chronic disease such as type 1 diabetes that may encourage non-adherence to self-care [22].

Parental involvement, communication, cohesion and family conflicts that arise when man‐ aging diabetes self-care, are good examples of the type of family support available to the adolescent. A higher level of family conflict and less involvement account for worse out‐ comes of adherence to diabetes self-care in adolescents [28]. In turn, schools with staff and peers also account from other sources of social support that the adolescent with type 1 dia‐ betes may count on, in daily life, that may influence metabolic control and quality of life [29]. Peer pressure and the demands of the social environment (school, recreational activities and family) may hinder adherence to self-care in adolescents with diabetes [30, 31].

This chapter's main goal is to describe the relationship among family support, school sup‐ port and parental coping in adolescents with type 1 diabetes on adherence to self-care in or‐ der to inform the development of interventions programs to meet adolescents' needs regarding diabetes management.
