Improving Adherence in Type 1 Diabetes by Peer Mentoring: A Feasibility Study
Subcontract Principal Investigator:
Beth Pyatak PhD, OTR/L, CDCES, FAOTA
October 2011 to October 2013 | Total funding $7,169
Children's Hospital Los Angeles (subcontract from CHLA; primary award to CHLA from National Institutes of Health and National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK), 1R03DK094513-01) $7,169 (NIH/NIDDK award to CHLA $50,000)
Type 1 diabetes (T1D) is the second most common serious childhood disease in the US, with the rate of incidence accelerating in the most recent decade. Studies show that effective glycemic control decreases the risk of T1D-related secondary complications, highlighting the importance of glycemic control, which largely relies on individual patients’ adherence to their treatment regimen. However, adolescents and young adults with T1D often have particular difficulty adhering to the often burdensome daily demands of T1D self-care. While it is estimated that 10–25% of adult patients have poor glycemic control due to non-adherence, existing literature suggest that the rate of non-adherence among adolescents and young adults ranges from 30% to 67%. Non-adherence can include not eating nutritious meals, not checking blood sugar regularly, or missing insulin doses. As a result, adolescents and young adults constitute a subset of T1D patients at particularly high risk for negative health outcomes. Our previous studies and other literature show that lack of empowerment is a significant barrier to adherence among adolescents and young adults. This study assessed the feasibility of a peer mentoring program which pairs adolescents with T1D with young adults with T1D who have successfully navigated the transition to adulthood, as a means of enhancing empowerment in both populations. The study surveyed adolescents and young adults on their diabetes self-care, barriers to adherence, social support, mental well-being, and peer mentoring preferences.
Lu, Y., Pyatak, E. A., Peters, A. L., Wood, J. R., Kipke, M., Cohen, M., & Sequeira, P. A. (2015). Patient perspectives on peer mentoring: Type 1 diabetes management in adolescents and young adults. The Diabetes Educator, 41(1), 59-68. https://doi.org/10.1177/0145721714559133 Show abstract
Purpose. The purpose of the study was to identify attitudes and topics relevant to peer mentoring as an adherence-promoting intervention for adolescents and young adults (YAs) with type 1 diabetes (T1D).
Methods. Self-administered survey data were collected in 2 diabetes clinics from a convenience sample of adolescents as prospective mentees (ages 13-18) and YAs as prospective mentors (ages 19-25) with T1D. Survey topics included demographics, disease history, glycemic control, adherence, depression, barriers to disease management, social support, and interest in peer mentoring. Descriptive statistical analyses, thematic coding, and stepwise multivariate logistic regression were performed.
Results. A majority of the 54 adolescents and 46 YAs expressed interest in a peer mentoring program. Having supportive friends and living in a large household positively predicted adolescent interest in having a peer mentor. Approximately one-third of all participants experienced social barriers to diabetes management. For adolescents, barriers included inflexible schedules, unfamiliar foods, and the embarrassment of checking blood glucose in front of others. Young adults reported barriers in tracking food consumption and remembering to check blood glucose. Various diabetes management skills were in high demand by adolescents, who especially desired to learn about managing T1D on their own and in college. Participants were open to multiple communication modes, including in-person meetings, phone, text messaging, and social media.
Conclusions. Many adolescents and young adults with T1D are interested in peer mentoring as a way to facilitate learning and sharing essential diabetes management skills and experiences.