“…Part of My Identity”: The Impact of Self-Management on the Sense of Self of Young Women With Type 1 Diabetes

Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review

Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.

The transition experiences of adolescents with type 1 diabetes from paediatric to adult care providers

PURPOSE

Emerging adults with type 1 diabetes (T1D) are at increased risk for poor health outcomes as they transition from paediatric to adult healthcare providers. This is in part due to the complexities of young adult life as individuals with T1D enter the workforce, leave home or start college while learning to manage the disease on their own. We sought to identify the barriers and facilitators adolescents face during their emerging adult years with T1D.

METHODS

Young adults, aged 24-35, who lived with T1D during their adolescent years were recruited online to complete a survey regarding their experience with care transition. Categorical data were analysed using descriptive statistics. A thematic analysis, guided by the Framework for Emerging Adults with T1D, was used to explore the free-text data.

RESULTS

In total, 25 adults (84% female) with mean age of 28 ± 3.2 years participated. Themes that arose from the analysis of the paediatric to adult care transition experiences included (1) importance of support from key players, (2) challenges navigating the healthcare system, (3) mental health needs of emerging adults with T1D, (4) managing day-to-day life with T1D and (5) early independence to ease transition.

CONCLUSION

Individuals with T1D face a variety of challenges as they transition from paediatric to adult care providers. A proactive approach in educating adolescents is needed.

How Do the Challenges of Emerging Adulthood Inform our Understanding of Diabetes Distress? An Integrative Review

PURPOSE OF REVIEW

Emerging adulthood (ages 18-29) presents many emotional, social, and developmental challenges that can contribute to an increased sense of burden when managing type 1 diabetes (T1D). Diabetes distress (DD) is the concept that captures the emotional burden, frustrations, and worries resulting from living with T1D. This integrative review sets out to examine the impact of developmental context by answering this question: How do the challenges of emerging adulthood inform our understanding of DD?

RECENT FINDINGS

DD is highly prevalent in emerging adults and occurs at higher rates than in other age groups. Qualitative studies reveal that DD is embedded within the developmental challenges specific to living with T1D during this stage. Quantitative studies reveal the prevalence and correlates of DD in this age group, and qualitative studies augment these findings by capturing the scope and complexity of the emotional burden of living with T1D as an emerging adult.

Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes

PURPOSE

The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored.

METHODS

A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected.

RESULTS

The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM.

CONCLUSIONS

The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.