The impact of transitioning from childhood to adolescence on self-management of type 1 diabetes

Abstract

Overview of the topic: The transitional period of adolescence is challenging due to physical and social development which may cause increased stress and anxiety. Diabetes self-management requires intensive efforts and apart from the developmental challenges, teens with T1DM have the added burden of self-care (Timms and Lowes, 1999). Poor glycaemic control is common amongst adolescents (Cohen, Lumley, NaarKing, Partridge and Cakan, 2004) and this may be attributable to the psychosocial and behavioural factors that characterise the pubertal years (Arriel & Simonson, 1986). This dissertation is designed to review literature on the influence of the transition period from childhood to adolescence on diabetes self-management. The research question: Amongst adolescents with T1DM, does the transitioning period from childhood to adolescence influence their diabetes self-management? The PEO framework: Population (P) adolescents with type 1 diabetes mellitus (T1DM); exposure (E) the transitioning period from childhood to adolescence; outcome (O) diabetes self-management. Methods: The key elements of the PEO question were recognised and their synonyms were combined using the Boolean operators. Various databases such as; CINAHL Plus, Scopus and Medline ProQuest were searched using limiters to narrow the search. Relevant studies were identified through the PRISMA 2009 check list and the inclusion and exclusion criteria which only included articles that focus on diabetes selfmanagement amongst adolescents. The studies were appraised using the Critical Appraisal Skills Program (CASP) and the Appraisal tool for Cross-sectional studies (AXIS). Results: A prospective cohort study and five cross-sectional studies were identified. The studies of this review showed that several behavioural and psychosocial factors that occur during adolescence had an impact on diabetes self-management. However, several limitations of the studies and inconsistency between data reporters was noted. Thus, further research in this area is required. Conclusion: This review cannot draw a definite conclusion; although it showed that, the transitioning period of adolescence is a time of risk for the self-management of T1DM. Several factors which could influence self-management were identified, including parental relationships, self-efficacy and negative live events. Recommendations: Adolescents with T1DM should be screened for their level of diabetes self-efficacy and for negative life events to prevent deteriorated diabetes management. Peer pressure and stress may be reduced if insulin pumps and continuous BGM devices are offered to youths for free. Consequently, more nurses specialised in diabetes care are required to offer individualised care and to improve diabetes education amongst youths.