Understanding cognitive, emotional, and social aspects in diabetes (type 1) self-management in young adults

背景：1型糖尿病(T1D)是一种胰腺分泌胰岛素不足的慢性疾病。患者必须对自我管理行为做出复杂的决定，以将血糖水平保持在安全范围内，并减少长期并发症。患者必须遵循密集的多次胰岛素注射方案，根据食物摄入量、运动和其他因素持续调整胰岛素剂量，而情绪和认知会受到低血糖和高血糖水平的影响。糖尿病的苛刻性质往往会导致患者经历与糖尿病相关的痛苦。患有T1D的年轻人，特别是大学生，很难进行良好的自我管理，也不太可能寻求医疗支持。这不仅增加了心理健康问题的风险，也是导致26%的糖尿病大学生因糖尿病并发症而住院的因素。我的项目旨在了解年轻人是如何在需要治疗低血糖或高血糖时决定服用胰岛素或葡萄糖的。心理学是理解这一点的关键，因为成功的自我管理依赖于认知能力和弹性人格来处理复杂的决定和糖尿病对心理健康的影响。新的可用的糖尿病技术(例如葡萄糖传感器)最近改变了自我管理，但很少或根本没有研究探索为什么年轻人没有有效地使用这项技术。此外，还没有全面了解成年人对糖尿病自我管理做出的决定。研究问题：青年糖尿病患者的自我管理涉及什么？他们如何做出关于糖尿病自我管理的决定？为什么这些决定不能达到理想的血糖值安全范围？研究方法：这项多方法项目将聚焦于80名糖尿病患者，完成3项研究，因为这是成年人中自我管理问题最多的年龄段。这在我最后一年的心理学论文中的初步研究中得到了证实。研究1将通过半结构访谈来分析年轻人如何管理他们的糖尿病。该研究的目的是详细了解学生如何根据不同的社交和个人情况做出自我管理的决定。研究2将探索两周内不同血糖水平下的自我管理行为和情绪。参与者每天将使用一款应用程序多次记录他们的血糖水平、情绪和对血糖水平做出的决定。这将为深入了解各种血糖值的心理相关性提供依据。在为期两周的研究期间，将收集葡萄糖传感器数据。研究3将让参与者完成一系列认知测试，以研究不同血糖水平对认知的影响。这将与一组年龄和社会经济状况相匹配的健康对照组进行比较。该项目将提高该领域对年轻人对血糖变化做出的决定的理解，以及为什么在这一队列中很难实现最佳的自我管理。这一结果将为医疗保健和大学服务部门提供信息，说明如何更好地支持患有糖尿病的年轻人在高危时期过上健康的生活，希望能改善健康状况，减少长期并发症。

Background: Diabetes type 1 (T1D) is a chronic disease in which the pancreas producesinsufficient amounts of the hormone insulin. Patients must make complex decisions about self-managementbehaviour to keep blood glucose levels within a safe range and reduce long-termcomplications. Patients must follow an intensive regime of multiple insulin injections,continuously adjusting insulin dosage depending on food intake, exercise, and other factorswhile mood and cognition are affected by low and high glucose levels. The demanding nature ofdiabetes often causes patients to experience diabetes-related distress. Young adults with T1D,particularly university students, struggle to practice good self-management and are less likely toseek medical support. This not only presents an increased risk of mental health challenges butalso factors into 26% of university students with diabetes being hospitalised due to diabetescomplications. My project aims to understand how young adults make decisions about takinginsulin or glucose when needed to treat low or high blood glucose levels. Psychology is key tounderstanding this, because successful self-management depends on the cognitive ability andresilient personality to deal with complex decisions and the effects of diabetes on mental health.New available diabetes technologies (e.g., glucose sensors) have recently changed self-management,but little to no research exists exploring why young adults don't use thistechnology effectively. Additionally, there is no comprehensive understanding of what decisionsyoung adults make regarding diabetes self-management.Research Questions: What does self-managementin young adult diabetes patients involve and how do they make decisions aboutdiabetes self-management? Why are these decisions not leading to the ideal safe range of bloodglucose values?Methodology: This multi-methodology project will focus on young adults withdiabetes (N =80) completing 3 studies, as this is the adult age group experiencing most selfmanagementproblems. This was confirmed by my preliminary research in my final yearpsychology thesis. Study 1 will analyse how young adults manage their diabetes using semistructuredinterviews. The aim is to gain a detailed understanding of how students makedecisions about their self-management depending on different social and personal situations.Study 2 will explore self-management behaviour and mood during different glucose levels over aperiod of 2 weeks. Participants will record their glucose level, mood, and decisions in response totheir glucose level multiple times each day using an app. This will provide an in-depth insight ofpsychological correlates of a variety of blood glucose values. For the period of the two-weekstudy, glucose sensor data will be collected. Study 3 will involve participants completing abattery of cognitive tests to study how cognition is affected during different blood glucose levels.This will be compared to a group of age and socio-economically matched healthy controls.Impact This project will improve the field's understanding of the decisions young adults make inresponse to glucose variations and why optimal self-management is difficult to achieve in thiscohort. The results will inform healthcare and university services on how to better support youngadults with diabetes live a healthy life during a high-risk period, in the hope of improvingwellbeing and reducing long-term complications.