**1. Introduction**

Approximately 1 in every 400 to 600 children has Type I diabetes. The care of children with Type I diabetes involves complex procedures including daily blood glucose testing, dietary monitoring, intensive insulin therapy, and physical activity to maintain metabolic control in the face of pancreatic failure. The aforementioned procedures as well as adjustment of insu‐ lin doses based on blood glucose monitoring are critical areas for adherence to the medical regimen. The work and complexity of maintaining a diabetes regimen can lead to adherence issues for children and their families [4,5]. Adhering to diabetes regimens, however, is relat‐ ed to long-term positive health outcomes. If children do not take care of their diabetes they can experience problems with their vision as well cardiovascular issues and circulation problems. This chapter reviews critical issues for adherence for children and adolescents. Ideas for improving adherence also are presented.

Only about 50% of adults and children with chronic illnesses follow or adhere to their medi‐ cal regimens. Adherence is a very important area of study for adolescents with Type I diabe‐ tes, because managing this disease involves multiple strategies including diet, exercise, and glucose monitoring as well as administering medication [9,10]. The early teenage years also are a peak time in terms of incidence rates for developing diabetes, and puberty is a difficult time to manage insulin levels, because adolescents may have decreased insulin sensitivity and poor self-management skills [11]. In this chapter we use the terms adherence and selfmanagement to discuss a child's diabetes care and how well a child's medical regimen is fol‐ lowed. The terms are similar, but it is important to define self-management as a broader concept that involves diabetes management activities by the child and his or her caregivers. Adherence is often more narrowly defined as following one's medical regimen. Both terms

© 2013 Nabors and Bartz; 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.

are important and critical as adherence and good self-management lead to positive health outcomes for youth who have diabetes.

the later years and good management in childhood can also transfer to the adolescent years, making good adherence practices a pattern of behavior that is a resilience factor for a child

Type I Diabetes in Children: Facilitating Adherence to Medical Regimens

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The clinician or health care provider should assess parent reactions and strategies for coping with misbehavior during mealtime, when he or she is working with parents of younger chil‐ dren. Wilson, DeCourcey, and Freeman found that over-reaction and over-correction of mealtime problems was associated with relatively poor parental coping and management of the child's diabetes. These researchers speculated that, "parents who perceive themselves as over-reactive may be removing themselves from oversight of the illness (p. 220)." Children, in turn, appear to benefit from parental guidance and education. Patton et al. assessed young children's mealtime behaviors with parents [15]. Children were between the ages of two and eight years, with a mean age of approximately five and a half years. Children who were in poorer control, with relatively poorer diabetes management, had mealtime relation‐ ships with their parents that were characterized by rigidity and coercive feeding behaviors on the part of parents. Increasing positive and open communication between children with Type I diabetes and their parents or caregivers also may lead to improved parent-child in‐ teractions and positive diabetes management. Wilson et al. proposed that longitudinal stud‐ ies should be conducted to gain a greater understanding of the ways that parent-child interactions support diabetes management. Health professionals and clinicians should strive to advise parents about and assist them in developing a pattern of positive mealtime interac‐

Self-efficacy for diabetes management is grounded in a social cognitive approach, which em‐ phasizes a "can do" attitude toward managing problem situations [16]. The adolescent should be encouraged to think of him- or herself as being able to complete diabetes manage‐ ment tasks that he or she is capable of managing, and be encouraged to gain expertise and master new skills, such as administering his or her own insulin. The tasks assigned to the adolescent should be commensurate with his or her abilities so that he or she can master the self-management task and move to a higher level of self-efficacy for working with his or her diabetes. Berg et al. also stated that high feelings of self-efficacy for managing diabetes may be especially helpful for adolescents with "acting out" behavior problems or *externalizing*

Another important thing to address is fear of hypoglycemia or hyperglycemia, especially with adolescents and their parents. Battista, Hart, Greco, and Gloizer assessed adolescent re‐ port of diabetes management for youth with Type I Diabetes for adolescents between the ages of thirteen to eighteen [18]. The youth in their sample were experiencing social anxiety. These authors thought it was important to assess social anxiety as it might be a factor contri‐ buting to poor diabetes management and because social anxiety might contribute to poor diabetes management when an adolescent was in social situations with peers. Their findings

throughout his or her life.

tions with their child.

problems [17].

**3. Adolescents and diabetes management**
