Defining features of diabetes resilience in emerging adults with type 1 diabetes

Abstract

Background Emerging adulthood presents unique challenges for type 1 diabetes (T1D) management. Barriers to achieving optimal diabetes outcomes have been studied but less is known about how emerging adults overcome these challenges. Characterizing emerging adults' protective factors may help guide T1D care during this developmental period. We anticipated identifying social, cognitive, and behavioral protective factors and were open to additional themes. Methods We analyzed transcripts from semi‐structured qualitative interviews with 62 emerging adults (age 18‐24 years) with T1D using hybrid thematic analysis. Interviews queried about participants' perspectives on diabetes management challenges, how they overcome challenges, and diabetes resilience. Results We categorized responses into three types of protective factors: (a) Social: Interpersonal strategies such as obtaining tangible support (especially from parents) and emotional support from friends, medical professionals, and community leaders. (b) Cognitive: Believing one can live a “normal” life with T1D, benefit‐finding, and viewing diabetes management as an important part of life. (c) Behavioral: Proactively planning for diabetes challenges, maintaining a consistent routine while allowing for flexibility, balancing diabetes and non‐diabetes activities, and using diabetes‐specific and general technologies to support self‐management. Conclusions The adaptive approaches emerging adults with T1D use to handle the challenges of diabetes include seeking interpersonal support, managing their thoughts about T1D, and taking specific actions to prevent or resolve challenges. Helping emerging adults identify and strengthen their protective factors has potential to affect clinical outcomes. Strengths‐based assessment and clinical attention to protective factors may prepare adolescents to successfully manage the challenges of transition to adult care.

ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes

“…Attention to protective skills and behaviors (i.e., strengths) that promote resilient outcomes can enhance understanding of adjustment to diabetes and have implications for clinical care. These strengths include confidence or self‐efficacy to manage the demands of diabetes, seeking and receiving developmentally appropriate help and support from family and others, and adaptability to handle unpredictable diabetes‐related challenges (e.g., effective problem‐solving and coping) 27–31 . Children and families who use adaptive coping strategies such as problem‐solving have a better QoL and family functioning, and report fewer depressive and anxiety symptoms 32–36 .…”

ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes

“…113 It is crucial that the diabetes team identify and address these issues, 114,115 by providing problem-oriented interactive education that may include integrating technology, revisiting daily routines and treatment options, ensuring mental health support, and restoring communication and balance within the family. [116][117][118][119] Language used by the diabetes care team is crucial for building a strong relationship. It should be kept accessible and simple, motivating, compassionate, yet realistic, not judging or shaming and adjusted to the personal preferences of the child with diabetes.…”

Here for You: A Review of Social Support Research in Young Adults With Diabetes

“…Social support can be diabetes-specific or general, both of which can be emotional, tangible/instrumental (i.e., concrete assistance, including financial support), and informational. In a qualitative study characterizing protective factors and strengths, young adults with type 1 diabetes reported receiving both tangible and emotional support from a wide range of sources, including family, friends, health care professionals, and people in the community; they consistently emphasized the benefits of receiving both types of support (26). Social support occurs both in person and online, including via personal friendships and interactions, support or socialization groups, video chats, text messaging, social media platforms, and online community forums.…”

“…While some health care professionals (HCPs) may view independence from parents/caregivers and transition to adult care during this developmental period as a "natural process" that young adults are "ready" for (30), it has also been argued that the "myth of independence" inappropriately expects autonomy and fails to capture the helpful role that parents continue to play during young adulthood (31). Specific forms of parental support (e.g., financial, practical, and emotional assistance) are beneficial and highlight the importance of parents' ongoing involvement into young adulthood (26). Parents often continue to provide tangible support, assisting with diabetes-related tasks such as ordering supplies, making appointments, and providing financial assistance for medications or medical copayments (28,29).…”

“…Results of a systematic review suggested that HCPs often provide primarily informational support to young adults and older adults with type 2 diabetes as a strategy to increase knowledge and encourage behavioral change (51). Qualitative research has highlighted the complexity of these relationships; young adults with type 1 diabetes perceive HCPs as a helpful source of social support (26), and social isolation has been connected to negative relationships with diabetes care providers (52).…”