A self-regulation approach to diabetes adherence into emerging adulthood

描述(由申请人提供)：青春期后期和成年初期(18岁以上)对坚持糖尿病治疗方案构成巨大挑战，这导致代谢控制不力，增加了严重长期健康并发症(如低血糖和酮症酸中毒、微血管疾病和过早死亡)的风险。随着新兴成年人走出家庭和儿科医疗保健系统，他们面临着新的挑战。这些挑战需要以一种更独立于父母的方式对一个人的情绪、认知和行为进行日常监管。此外，发展神经科学的进步表明，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结合起来，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展的时候。越来越多的证据表明，成年初期是高风险时期，但很少有研究表明，患有糖尿病(或任何慢性病)的成年初期是如何成功实现这一转变的。这项拟议的研究建立在我们先前工作的基础上，即父母监督有助于通过加强青少年自身的自我调节技能(例如，维持糖尿病目标、防止问题发生、在问题发生时进行调整)以及在这些技能尚未发展时对这些技能进行补偿，从而有利于在整个青春期保持遵守。我们将研究仍在发展中的神经认知能力是否限制了晚期青少年调节糖尿病问题和坚持治疗方案的能力，并将确定父母的监测是否可能继续弥补神经认知能力低下的影响。在两个地点(犹他州和德克萨斯州)的纵向观察设计中，250名患有1型糖尿病的青少年将在他们高中四年级的秋季被招募，并在三年内每年进行一次评估。在目标1中，我们通过行为测试和相应的自我报告和父母报告，确定在过渡到成年的过程中，需要哪些神经认知能力(例如，执行功能、冲动控制、注意力控制)来保持忠诚度。在目标2中，我们使用在高中和高中后进行的两个为期14天的日记，确定这些神经认知能力如何与过渡期间最佳坚持所需的日常自我调节有关。在目标3中，我们研究了过渡到新兴成年期的父母监控是否有利于那些神经认知能力较低的人，并探索了父母仍然能够监控日常新兴成年人的行为的方式(例如，短信、电话、面对面)。这一发现将对使用针对晚期青少年自我调节技能的家庭干预措施具有重要的临床应用价值。 与公共卫生相关：青春期后期和成年期早期是患有1型糖尿病的青年的高风险时期(例如，依从性和代谢控制不佳、失去医学随访、出现并发症)，这是由于青年从家庭和儿科护理过渡而发生的变化。这项拟议的研究确定了在整个过渡期间保持遵守所需的神经认知和日常自我调节技能，并探索了当青少年不再住在家里时，父母是否以及如何继续促进遵守。这些发现将提供信息，为在青年过渡到成年时促进更好的依从性和糖尿病管理的新干预措施提供信息。

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.