A self-regulation approach to diabetes adherence into emerging adulthood

成年初期糖尿病依从性的自我调节方法

• 批准号: 8287060
• 负责人: Cynthia A Berg
• 金额: $ 55.86万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8287060
• 关键词: Adherence; Adolescence; Adolescent; Adult; Age; Attention deficit hyperactivity disorder; Behavior; Behavior Control; Blood Glucose; Caring; Childhood; Chronic Disease; Clinic; Clinical; Cognition; Cognitive; Complex; Development; Diabetes Mellitus; Diabetic Angiopathies; Electronic Mail; Emotional; Emotions; Equipment and supply inventories; Family; Friends; Gambling; Goals; Health; Healthcare Systems; Home environment; Hypoglycemia; Incentives; Individual; Informal Social Control; Insulin-Dependent Diabetes Mellitus; Intervention; Iowa; Life; Link; Measures; Medical; Metabolic Control; Monitor; Moods; Neurocognitive; Neurosciences; Parents; Patient Self-Report; Persons; Premature Mortality; Process; Recruitment Activity; Regimen; Regulation; Reporting; Research; Risk; Self Efficacy; Site; Telephone; Testing; Texas; Text; Thinking; Time; Utah; Work; Youth; behavior measurement; behavior rating scale; behavior test; blood glucose regulation; clinical application; cognitive control; cognitive function; college; design; diabetes management; diaries; emerging adult; emerging adulthood; executive function; experience; falls; follow-up; high risk; high school; innovation; interest; novel; parental monitoring; performance tests; prevent; skills; social; young adult

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.

描述（由申请人提供）：青春期晚期和成年初期（18岁以上）对糖尿病治疗方案的坚持提出了巨大的挑战，这会导致代谢控制不良和严重的长期健康并发症（如低血糖和酮症酸中毒，微血管疾病和过早死亡）的风险增加。新兴的成年人经历新的挑战，因为他们走出家庭和儿科医疗保健系统。这些挑战需要以一种更独立于父母的方式来日常调节自己的情绪、认知和行为。此外，发展神经科学的进展表明，青少年晚期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展的时候。越来越多的证据表明，成年初期是一个高风险的时期，但很少有研究表明，患有糖尿病（或任何慢性疾病）的成年初期是如何成功过渡的。提出的研究建立在我们之前的工作的基础上，即父母的监督有利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，并在问题发生时进行调整）来维持青少年的依从性，并在这些技能尚未发展时对其进行补偿。我们将检查仍在发育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，250名患有1型糖尿病的青少年将在他们高中最后一年的秋季被招募，并在三年内每年进行评估。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，确定哪些神经认知能力（例如，执行功能，冲动控制，注意力控制）需要在过渡到初成人期间保持依从性。在目标2中，我们确定了这些神经认知能力与过渡期间最佳依从性所需的日常自我调节之间的关系，使用了在高中和高中后一年进行的两个14天日记。在目标3中，我们研究了父母在过渡到初成期的监控是否有益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初成期行为的方法（例如，短信、电话、面对面）。研究结果将有重要的临床应用，使用家庭干预量身定制的自我调节技能的青少年晚期。