A self-regulation approach to diabetes adherence into emerging adulthood

描述（由申请人提供）：青春期后期和成年期（18岁以上）对坚持糖尿病治疗方案提出了巨大的挑战，这导致代谢控制不良和严重长期健康并发症（例如，低血糖和酮症酸中毒、微血管疾病和过早死亡）。新兴的成年人经历了新的挑战，因为他们走出家庭和儿科医疗保健系统。这些挑战需要一个人以一种更加独立于父母的方式对自己的情绪、认知和行为进行日常调节。此外，发展神经科学的进展表明，晚期青少年还不能将他们的思维与日常生活的社会和情感需求相结合，这表明这些挑战发生在调节情绪，认知和行为所需的神经认知能力尚未完全发育的时候。越来越多的证据表明，成年初显期是一个高风险的时期，但很少有研究能够告知患有糖尿病（或任何慢性疾病）的成年初显期患者如何成功地实现这一转变。这项拟议的研究建立在我们先前的工作基础上，即父母的监督有利于通过加强青少年自己的自我调节技能（例如，维持糖尿病目标、预防问题发生以及在问题发生时进行调整），并在这些技能尚未发展时进行补偿。我们将研究神经认知能力的发展是否会限制晚期青少年调节糖尿病问题和坚持治疗方案的能力，并将确定父母的监护是否可以继续补偿低神经认知能力。在两个地点（犹他州和德克萨斯州）的纵向观察设计中，将在高中高年级秋季招募250名1型糖尿病青少年，并每年评估一次，持续三年。在目标1中，我们确定哪些神经认知能力（例如，执行功能、冲动控制、注意力控制），以通过行为测试和相应的自我和父母报告在向成年初显过渡期间保持依从性。在目标2中，我们确定这些神经认知能力如何与过渡期最佳依从性所需的日常自我调节相关，使用在高中和高中后进行的两个14天日记。在目标3中，我们研究了父母在向成年期过渡期间的监控是否有益于那些神经认知能力低下的人，并探索了父母保持监控日常成年期行为的方式（例如，短信、电话、当面）。研究结果将有重要的临床应用，为后期青少年的自我调节技能的家庭干预措施的使用。 公共卫生相关性：青春期后期和成年早期的发育期是1型糖尿病青年的高风险时期（例如，依从性差和代谢控制不佳、失去医疗随访、出现并发症），这是由于年轻人从家庭和儿科护理过渡时发生的变化。拟议的研究确定了在这一转变过程中保持依从性所需的神经认知和日常自我调节技能，并探讨了当青少年不再住在家里时，父母是否以及如何继续促进依从性。这些发现将提供信息，可以为新的干预措施提供信息，以促进更好的依从性和糖尿病管理，作为青年向成年过渡。

DESCRIPTION (provided by applicant): Late adolescence and emerging adulthood (ages 18+) pose formidable challenges for adherence to the diabetes regimen, which contribute to poor metabolic control and increased risk for serious long-term health complications (e.g., hypoglycemia and ketoacidosis, microvascular disease, and premature mortality). Emerging adults experience new challenges as they move out of the home and the pediatric health care system. These challenges require daily regulation over one's emotion, cognition, and behavior in a way that is more independent from parents. Further, advances in developmental neuroscience reveal late adolescents are not yet able to integrate their thinking with the social and emotional demands of daily life, suggesting that these challenges occur at a time when the neurocognitive abilities needed to regulate emotion, cognition and behavior are not fully developed. There is increasing evidence that emerging adulthood is a time of high risk, but there is little research to inform how emerging adults with diabetes (or any chronic illness) make this transition successfully. The proposed research builds on our prior work that parental monitoring is beneficial for maintaining adherence across adolescence by bolstering adolescent's own self-regulatory skills (e.g., maintaining diabetes goals, preventing problems from occurring, and adjusting to problems when they do occur) and compensating for such skills when they are not yet developed. We will examine whether still developing neurocognitive abilities limit late adolescents' ability to regulate diabetes problems and adhere to the regimen, and will determine whether parental monitoring may continue to compensate for low neurocognitive abilities. In a longitudinal observational design at two sites (Utah and Texas), 250 adolescents with type 1 diabetes will be recruited in the Fall of their senior year of high school, and assessed annually for three years. In Aim 1, we identify which neurocognitive abilities (e.g., executive function, impulse control, attentional control) are needed to maintain adherence across the transition to emerging adulthood through behavioral tests and corresponding self- and parent-reports. In Aim 2, we determine how these neurocognitive abilities relate to the daily self regulation needed for optimal adherence across the transition, using two 14-day diaries conducted in the senior and post senior high year. In Aim 3, we examine whether parental monitoring across the transition to emerging adulthood benefits those with low neurocognitive abilities, and explore the ways in which parents remain able to monitor daily emerging adults' behavior (e.g., text, phone, in person). The findings will have important clinical applications for the use of family interventions tailored to the self-regulatory skills of late adolescents. PUBLIC HEALTH RELEVANCE: The developmental period of late adolescence and early adulthood is a time of high risk for youth with type 1 diabetes (e.g., poor adherence and metabolic control, loss to medical follow-up, development of complications), due to the changes that occur as youth transition from the family home and pediatric care. The proposed research identifies the neurocognitive and daily self-regulation skills that are needed to maintain adherence across this transition, and explores whether and how parents may continue to facilitate adherence when adolescents are no longer living at home. The findings will provide information that can inform novel interventions to promote better adherence and diabetes management as youth transition to adulthood.