A team of Yale researchers has found that teaching coping skills to adolescents with diabetes significantly improves their metabolic control over the disease as well as their overall quality of life.
"If the gains made by the adolescents in our study can be maintained, they can expect a 25 percent reduction in long-term complications," says Margaret Grey, associate dean and the Independence Foundation Professor at the Yale School of Nursing, who is the study's principal investigator.
Since the landmark Diabetes Control Complications Trial in 1993, there has been a change in the way that Type-1 diabetes (commonly referred to as juvenile diabetes) is treated. That study found that intensive interventions -- such as the use of an insulin pump or multiple injections daily, as well as four or more daily blood tests -- reduced long-term complications from diabetes.
Despite the widespread adoption of this regimen, managing diabetes in adolescents remains difficult, says Grey. The biological changes of adolescence make even those without diabetes resistant to insulin, she explains, and these biological issues are compounded by psychosocial ones. As Grey puts it, "Teenagers in particular are difficult because they're teenagers."
The reasons why adolescents may not take the necessary steps to manage their diabetes range from resentment of parental control over scheduling injections to fear of appearing strange in front of their friends, notes Grey. For example, drinking alcohol affects blood sugar, but teens often feel peer pressure to drink, and sometimes believe that it is necessary to drink excessively to fit in, she says. "They don't want to be labeled a nerd."
Grey and her colleagues hypothesized that training adolescents in such areas as conflict resolution and bargaining techniques would help them do better with their diabetes. They took a sample of 77 adolescents receiving treatment for Type-1 diabetes and divided them into two groups. One group received standard treatment. The other received standard treatment plus coping skills training, based on a model originally devised to combat drug and alcohol abuse. The training took place in small group sessions, where adolescents had the opportunity to role play and practice problem-solving skills.
The researchers saw the adolescents start to use those skills in the management of their diabetes almost immediately. Grey points to the case of a teen who resented his mother's "nagging" him about his blood tests. He responded by not doing the tests, which are critical to the management of Type-1 diabetes because the necessary dosage of insulin can fluctuate dramatically. After the skills training, the young man agreed to keep track of his blood tests for several days, after which he would report them to his mother. Although he is not doing a perfect job, he is much improved, says Grey.
After six months, youths who had the skills training showed a 42 percent improvement in metabolic control, compared with peers who had not had the training. They also scored better on quality of life measurements, including reporting fewer worries about their diabetes.
In fact, there was such a dramatic improvement in the group receiving skills training that the researchers felt ethically compelled to offer the training to the control group as well.
"This is a relatively inexpensive, brief intervention that has real potential to help adolescents," says Grey.
The team's report has won the Applied Nursing Research Award, which
Grey accepted at the American Nurses Association Council for Nursing
Research Conference on June 26 in San Diego. The research will be
published in the journal Applied Nursing Research. At the San Diego
conference, Grey also presented the team's findings in the study, which
was funded by the National Institute of Nursing Research. Coauthors of the
study were Elizabeth Boland and Marianne Davidson, both lecturers at the
School of Nursing, and William Tamborlane, professor at the School of
Medicine and one of the investigators of the landmark Diabetes Control and
Complications Trial.
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