Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention.
Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention.
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DOI：
10.1097/mop.0b013e32833a46a7
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发表时间：
2010-08
影响因子：
3.6
通讯作者：
Laffel L
中科院分区：
文献类型：
--
作者：
Borus JS;Laffel L
尽管有有效的治疗方法，但与其他儿科年龄组相比，1 型糖尿病青少年对治疗方案的依从性较差。不依从性与血糖控制不佳、发病率增加和过早死亡风险密切相关。本文将回顾依从性的障碍，并讨论在改善该人群的治疗结果方面已显示出希望的干预措施。青少年在依从性方面面临许多障碍，包括发育行为、家庭动态的变化和感知的社会压力，这些都加剧了青春期生理带来的相对胰岛素抵抗。一些成功的干预措施依赖于鼓励家庭在血糖监测和胰岛素管理的日常任务中提供不带偏见的支持。其他干预措施通过使用动机性访谈和问题解决技术、饮食建议的灵活性以及通过技术扩大服务提供者的范围和支持来克服这些障碍。有效的干预措施建立在青少年的内部和外部支持（家庭、技术和内部动机）的基础上，以简化他们的糖尿病管理，并为青少年提供分担护理负担的机会。尽管此类策略有助于最大限度地减少对糖尿病青少年的需求，但大多数青少年的血糖控制可能会持续不佳，直到技术突破允许在闭环系统中自动输送胰岛素。
Despite the availability of effective therapies, adolescents with type 1 diabetes demonstrate poorer adherence to treatment regimens compared with other pediatric age groups. Nonadherence is tightly linked to suboptimal glycemic control, increasing morbidity, and risk for premature mortality. This article will review barriers to adherence and discuss interventions that have shown promise in improving outcomes for this population. Adolescents face numerous obstacles to adherence, including developmental behaviors, flux in family dynamics, and perceived social pressures, which compound the relative insulin resistance brought on by pubertal physiology. Some successful interventions have relied on encouraging nonjudgmental family support in the daily tasks of blood glucose monitoring and insulin administration. Other interventions overcome these barriers through the use of motivational interviewing and problem-solving techniques, flexibility in dietary recommendations, and extending provider outreach and support with technology. Effective interventions build on teens' internal and external supports (family, technology, and internal motivation) in order to simplify their management of diabetes and provide opportunities for the teens to share the burdens of care. Although such strategies help to minimize the demands placed upon teens with diabetes, suboptimal glycemic control will likely persist for the majority of adolescents until technological breakthroughs allow for automated insulin delivery in closed loop systems.