Introduction: Non-adherence to treatment is common in teenagers with type 1 diabetes (DM1). We aim to report on our experience, in a University teaching hospital, on factors leading to non-adherence, and describe strategies which improve compliance.
Discussion: There are numerous factors which account for why teenagers fail to adhere to treatment.
i) Lack of knowledge about the condition.
ii) Teenagers may not understand the importance of treatment. They view insulin administration as a burden as they do not perceive any immediate benefits.
iii) Affect and eating disorders
Exogenous insulin administration can lead to weight gain. Teenagers may choose to miss out their required insulin injections to fit into societys definition of healthy.
i) Peer relationships and acceptance.
ii) Teenagers with DM1 feel that their life lacks spontaneity. Feelings of isolation and stigma can make them adopt avoidant behaviour.
iii) Family support and social situation.
Rebellion against parental control contributes to non-compliance.
There are strategies which can be employed to improve adherence. These are as follows:
i) More frequent follow-up for high risk groups.
NICE guidelines advise weekly contact with patients having HbA1c levels >9.5%. Phone calls and home visits by diabetes nurses decrease acute admissions to hospital with diabetic ketoacidosis and hypoglycaemic episodes.
i) Family involvement.
The clinical psychologist aims to understand the difficulties of the teenager, and of their relatives. Interviewing them separately helps to recognise differences in their mindsets. Behavioural family systems therapy enhances family interactions and problem-solving skills.
ii) Motivational interviewing.
Motivational interviewing helps clinicians understand the inconsistencies in goal versus action in teenagers, with the aim of reiterating the importance of treatment. It has been shown to achieve better HbA1c levels.
Conclusion: Establishing treatment for teenagers with DM1 is challenging. It is essential for health professionals to understand the complex reasons behind non-adherence to successfully manage diabetes in teenagers.