Management of Type 1 Diabetes Among Adolescents

This 1-year study will explore the influences of family and peers on how diabetic
adolescents manage their disease, focusing on adolescent developmental transitions. The
management of diabetes is a complex process involving daily self-care activities,
problem-solving, and decision-making. It is particularly challenging during adolescence when
youth are experiencing physiological, social and psychological changes, and coming under
increasing peer influence and decreasing parental supervision. Although it is expected that
the responsibility for diabetes management will gradually shift from the parent to the child
during adolescence, research indicates that many children may be given responsibility for
managing their illness too early, without adequate parental monitoring. Specifically, this
study will examine the following issues:

- The relationship of peers, parents and school support to successful diabetes
management;

- The influence of the adolescent's self-image and personal goals on diabetes management;

- The influence of the adolescent's and parents' attitudes, capability and environment on
the balance of responsibility for diabetes management.

Children between 10 and 16 years of age receiving treatment for diabetes type 1 at
Georgetown University Medical Center's pediatric diabetes clinic may be eligible for this
study. The children must have been diagnosed with diabetes at least 1 year before entering
the study and must require insulin treatment. One parent of each child will also participate
in the study.

Children and their parents will complete the following procedures:

Home Interviews: Parents and children will complete two at-home face-to-face interviews 6
months apart. At each interview, children will answer questions about their responsibility
for and adherence to their diabetes management, treatment outcome expectations, optimism,
self-esteem, self-consciousness, personal goals, social support, perceived barriers to
diabetes management, family routine and family conflict, their parents' involvement in their
diabetes management, and parenting style. Parents will evaluate their child's ability to
manage his or her diabetes, level of maturity, self-esteem, and transition of
responsibility; their family routine and family conflict, parent-child communication, their
parenting goals, and their involvement in and responsibility for their child's diabetes
management. Three days after the 6-month interview, a randomly selected group of parents and
children will complete a brief, additional telephone interview covering some of the same
issues.

Telephone Interview: At 12 months, parents and children will complete a telephone interview
that will include questions about adherence to diabetes management and the responsibility of
parents and children for diabetes management.