Illness representations predict adherence in adolescents and young adults with type 1 diabetes

Objective: Most adolescents and young adults (AYAs) with type 1 diabetes struggle with diabetes self-management and exhibit suboptimal glycemic control. This study examined two models of association between illness representations, a modifiable predictor of suboptimal outcomes, and adherence and glycemic control in AYAs with type 1 diabetes.

Design and main outcome measures: Ninety-nine AYAs (ages 15–20 years) completed measures of illness representations and adherence at two visits. Blood glucose monitoring frequency and haemoglobin A1c were obtained via chart review. Relationships were examined using structural equation modelling.

Results: Illness representations accounted for a significant proportion of the variance in blood glucose monitoring frequency (ΔR ²= .23, p < .01) and adherence to emergency precautions at Time 1 (ΔR ²= .07, p = .03). Illness representations also accounted for significant variance in blood glucose monitoring frequency (ΔR ²= .08, p = .01), adherence to recommendations for insulin and food (ΔR ² = .08, p = .02) and exercise (ΔR ²= .10, p < .01), and adherence to emergency precautions (ΔR ²= .16, p < .01) at Time 2.

Conclusion: Illness representations are salient predictors of adherence in this population. Interventions targeting adherence promotion and glycemic control in AYAs with type 1 diabetes may be enhanced by efforts to modify illness representations.