ORIGINAL RESEARCH
Dietary Self-Care in Adolescents with Type 1 Diabetes: Report from the Juvenile Diabetes and Dietary Study

https://doi.org/10.1016/S1499-2671(11)51007-XGet rights and content

ABSTRACT

OBJECTIVE: This study had 3 aims: a) to examine the relationships between metabolic control, self-perceptions of dietary self-care, types of motivation and parental autonomy support toward dietary self-care in adolescents with type 1 diabetes; b) to explore gender differences in the above variables; and c) to verify the extent to which types of motivation and autonomy support from parents predict metabolic control and dietary self-care.

METHODS: A consecutive series of 289 adolescent patients with type 1 diabetes, aged 11 to 17 years, was recruited from 2 pediatric diabetes outpatient clinics in the province of Québec between January and December 2003.

RESULTS: Metabolic control was found to be suboptimal, with mean glycated hemoglobin levels of 8.5% (SD 1.6). Dietary recommendations were generally carried out for autonomous reasons: that is, for the satisfaction and pleasure of eating healthfully (mean 3.62, SD 1.0, range 1–5) or because these activities were valued or considered important (mean 4.35, SD 0.8, range 1–5). Results also showed that the more adolescents performed these activities because they felt controlled or were amotivated, the more they presented poor dietary self-care and metabolic control. Similarly, regression analysis revealed that controlled regulation (ß 0.13, p<0.05) and amotivation (ß 0.13, p<0.05) toward dietary self-care predicted poor metabolic control. Analyses revealed no gender differences.

CONCLUSION: Minimizing sources of pressure to pursue dietary self-care could be a promising avenue for improving dietary self-care in adolescents with type 1 diabetes.

RÉSUMÉ

OBJECTIFS : Cette étude avait trois objectifs : a) examiner les liens entre le contrôle métabolique, les perceptions d'autogestion alimentaire, les types de motivation et le soutien à l'autonomie de la part des parents en matière d'observance du plan alimentaire chez les adolescents atteints de diabète de type 1; b) examiner les différences entre les sexes pour ce qui est des variables ci-dessus; et c) déterminer dans quelle mesure les types de motivation et le soutien à l'autonomie de la part des parents permettent de prédire le contrôle métabolique et l'observance du plan alimentaire.

MÉTHODES : Une série consécutive de 289 adolescents de 11 à 17 ans a été recrutée au Québec dans deux services de soins externes pour enfants atteints de diabète de type 1 entre janvier et décembre 2003.

RÉSULTATS : Les résultats ont montré que le contrôle métabolique était sous-optimal, le taux moyen d'hémoglobine glycosylée étant évalué à 8,5 % (écart type [ET] : 1,6). Les recommandations alimentaires étaient en général suivies pour des raisons autonomes, c'est-à-dire pour la satisfaction et le plaisir de manger sainement (moyenne de 3,62, ET de 1,0, écart de 1 à 5), ou parce que ces recommandations étaient considérées importantes (moyenne de 4,35, ET de 0,8, écart de 1 à 5). Les résultats ont aussi montré que plus les adolescents suivaient les recommandations parce qu'ils se sentaient contrôlés ou amotivés, plus leur observance et leur contrôle métabolique étaient médiocres. De la même façon, l'analyse de régression a indiqué que la régulation contrôlée (ß 0,13, p < 0,05) et l'amotivation (ß 0,13, p < 0,05) en matière d'autogestion alimentaire étaient des prédicteurs de contrôle métabolique médiocre. Les analyses n'ont pas révélé de différences entre les sexes.

CONCLUSION : Réduire au minimum les sources de pression en ce qui a trait aux comportements alimentaires pour-rait être prometteur pour l'amélioration de l'autogestion alimentaire chez les adolescents atteints de diabète de type 1.

Section snippets

INTRODUCTION

To keep blood glucose levels within a normal range, young patients with type 1 diabetes must perform a complex set of self-care activities, including insulin replacement and following a healthy diet as recommended in Health Canada's Eating Well with Canada's Food Guide (1). Specifically, this involves consuming a wide variety of foods from each of the 4 food groups that suit young patients’ nutritional needs, eating habits, lifestyle, ability and interest, and matching food consumption with

Procédure and participants

Data were obtained from the first wave of the Juvenile Diabetes and Dietary Study, a 3-year longitudinal study of dietary self-care in families of adolescents with type 1 diabetes (10). Participants were recruited at the outpatient clinics of 2 major pediatric diabetes centres in the province of Quebec. Rather than relying on a convenience sample of patients, efforts were invested in the identification of all patients with type 1 diabetes aged 11 to 17 years and who attended the 2 outpatient

Preliminary analysis

The demographic and lifestyle characteristics of participants are presented in Table 1. In total, 289 consecutive series of adolescents participated in this study (133 girls, 46%).There were no significant differences between boys and girls with respect to the number of medical complications related to diabetes, diabetes duration or age. Factors related to adolescents’ general self-care recommendations and practices are presented in Table 2. The mean number of glucose readings per day was 3.6

DISCUSSION

The present study aimed to document dietary self-care and motivation in adolescents with type 1 diabetes. Along with demographic and lifestyle information, diabetes self-care recommendations, practices and metabolic control were documented in a consecutive series of adolescents with type 1 diabetes. Results showed that adolescents performed up to 3 or more glycemic readings and insulin injections per day. Few had received physical activity counselling at diagnosis, but the majority were

AUTHOR DISCLOSURES

This study was conducted in partial fulfillment of the require- ments for the doctoral dissertation of Stéphanie Austin and was supported by the Social Sciences and Humanities Research Council of Canada, the Fonds Québécois de la Recherche sur la Société et la Culture and the Canadian Institutes of Health Research.

AUTHOR CONTRIBUTIONS

SA participated in the data collection, data analysis and interpretation, and in drafting the manuscript. CS participated in the study design, supervision of the data collection, and the critical revision of the manuscript. FG participated in the review of the data and the manuscript. AN participated in the review of the manuscript. Funding was secured by CS, FG, and AN.

ACKNOWLEDGMENTS

We thank the adolescents and their families who participated in this study. We also thank the pediatric diabetes staff at all participating hospitals, especially Dr Isabelle Bouchard and Dr Michel Lelièvre of the Centre Hospitalier de l'Université Laval and Dr Maria Buithieu of Sainte-Justine Hospital for their assistance and support throughout this project.

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