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

基本信息

批准号：
8461197
负责人：
Cynthia A Berg
金额：
$ 54.09万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
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/8461197
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

项目摘要

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）：青春期和新兴的成年后期（18岁以上）对遵守糖尿病方案的挑战构成了巨大的挑战，这会导致代谢不良的控制和严重长期健康并发症的风险增加（例如，低血糖症和酮症酸症和酮症酸症，微血管疾病，微血管疾病和过早疾病）。新兴的成年人在搬出家庭和小儿保健系统时面临新的挑战。这些挑战需要每天对自己的情绪，认知和行为的监管，以更独立于父母。此外，发育神经科学的进步表明，晚期青少年尚无法将自己的思维与日常生活的社会和情感需求融合在一起，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时发生。有越来越多的证据表明，新兴的成年是一个高风险的时期，但是几乎没有研究来告知新兴的糖尿病成年人（或任何慢性疾病）如何成功地过渡。拟议的研究以我们先前的工作为基础，即父母的监测有助于通过增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，并在尚未开发出这种技能时会赔偿问题）来维持青春期的依从性。我们将研究仍在发展神经认知能力是否会限制晚期青少年调节糖尿病问题并遵守该方案的能力，并确定父母的监测是否可能继续弥补低神经认知能力。在两个地点（犹他州和德克萨斯州）的纵向观察设计中，将在高中毕业时招募250名患有1型糖尿病的青少年，并每年评估三年。在AIM 1中，我们确定了哪些神经认知能力（例如执行功能，冲动控制，注意力控制），以通过行为测试以及相应的自我和父母报告来维持整个新兴成年的依从性。在AIM 2中，我们确定了这些神经认知能力如何使用在高级和高级高年级中进行的两份14天日记，这与整个过渡过程中最佳依从性所需的每日自我调节有何关系。在AIM 3中，我们检查了父母在过渡到新兴成年的过渡中是否受益于具有低神经认知能力的人，并探索父母仍然能够监控每日新兴成年人的行为的方式（例如，亲自，电话，电话，电话，电话）。这些发现将在使用针对后来青少年的自我调节技能的家庭干预措施中使用重要的临床应用。