Dilemmas and directions in the care of the diabetic teenager: the Arnold Bloom Lecture 1999

Dissimilarity in adolescent and maternal representations of Type 1 diabetes: exploration of relations to adolescent well-being

PURPOSE

To compare the illness representations of adolescents with Type 1 diabetes and their mothers, and to explore how congruence and incongruence influences adolescent psychological adjustment.

METHODS

A total of 30 adolescents (13-19 years) with Type 1 diabetes completed self-report questionnaires of illness representations and psychological well-being; 26 mothers completed the illness representation questionnaire.

RESULTS

t-Test and correlation analyses showed convergence on the majority of the illness representation dimensions with maternal representations differing significantly on only two dimensions: perceiving their adolescent's diabetes to have more serious consequences and to have a greater emotional impact. Computation of dissimilarity scores between mothers and adolescents, showed mothers to maximize the seriousness of diabetes across several dimensions, but no significant associations were found with adolescent psychological well-being.

CONCLUSIONS

Chronic illness in children and young people exists in a social context and the management of diabetes requires an ongoing supportive relationship between parent and child. The results show a high degree of consistency in the beliefs adolescents and their mothers hold, and such congruence is presumed to benefit psychological well-being. However, the mediators and moderators for family belief processes are unclear and several possibilities are discussed.

Achieving optimal diabetic control in adolescence: the continuing enigma

The transition from childhood through adolescence to adulthood is a difficult stage, particularly for patients with type 1 diabetes. The yearning for autonomy and independence, as well as the hormonal changes around the time of puberty, can manifest in poor glycaemic control. The focus on diet and weight increases the prevalence of eating disorders, compounding the difficulties in supervising diabetes patients. This can be exacerbated by the realisation that hyperglycaemia induces weight loss and the use of this knowledge to further manipulate diabetes control to gain a desired body image. The management of adolescents with type 1 diabetes is therefore challenging and requires close collaboration between psychological medicine and diabetes teams. This review describes the difficulties frequently encountered, with a description of four cases illustrating these points. Case 1 demonstrates the problem of needle phobia in a newly diagnosed patient with type 1 diabetes leading to persistent hyperglycaemia, the recognition of weight loss associated with this and the development of bulimia. The patient's overall management was further complicated by risk-taking behaviour. By the age of 24 years, she has developed diabetic retinopathy and autonomic neuropathy and continues to partake in risk-taking behaviour. Case 2 illustrates how the lack of parental support shortly after the development of type 1 diabetes led to poor glycaemic control and how teenagers often omit insulin to accommodate lifestyle and risk-taking behaviour. Case 3 further exemplifies the difficulty in managing patients with needle phobia and the fear of hypoglycaemia. Case 4 adds further weight to the need for parental support and the impact of deleterious life events on glycaemic control by manipulation of insulin dosage.