Yale Researchers Improve Health and Quality of Life For Teenagers With Diabetes

A team of Yale researchers has found that teaching coping skills to adolescents with diabetes significantly improves their metabolic control over the disease as well as their overall quality of life. The study has won the Applied Nursing Research Award, which will be presented at the American Nurses Association Council for Nursing Research Conference on June 26 in San Diego.

“If the gains made by the adolescents in our study can be maintained, they can expect a 25 percent reduction in long-term complications,” said Margaret Grey, principal investigator. The study, funded by the National Institute of Nursing Research, will be published in the journal Applied Nursing Research and presented at the conference.

Grey and her team found that after six months, youths who had received skills training showed a 42 percent improvement in metabolic control, which is highly significant in Type 1 diabetes (commonly referred to as juvenile diabetes), compared with peers who had not had the training. They also scored better on quality of life measurements, including reporting fewer worries about their diabetes.

Grey is associate dean and the Independence Foundation Professor at the Yale School of Nursing. Co-authors of the diabetes study were Elizabeth Boland and Marianne Davidson, both lecturers at the Yale School of Nursing, and William Tamborlane, professor at the Yale School of Medicine. Dr. Tamborlane is one of the investigators of the landmark Diabetes Control and Complications Trial.

Managing diabetes in adolescents is particularly difficult. The biological changes of adolescence make young people – including those without diabetes – resistant to insulin. The biochemical issues are compounded by psychosocial ones.

The reasons why adolescents may not manage their diabetes well range from resentment of parental control over scheduling injections to fear of appearing strange in front of their friends, Grey said. For example, drinking alcohol affects blood sugar. But teens often feel peer pressure to drink, and some believe that it is necessary to drink excessively to fit in.

Grey and her colleagues hypothesized that training adolescents in such areas as conflict resolution and bargaining techniques would help them do better with their diabetes. The researchers took a sample of 77 adolescents receiving treatment for Type-1 diabetes. The youths were divided into two groups. One received standard treatment. The other received standard treatment plus coping skills training, based on a model originally devised to combat drug and alcohol abuse. The training took place in small group sessions, where adolescents had the opportunity to role play and practice good problem solving skills.

Researchers saw adolescents start to use those skills in the management of their diabetes. Grey pointed to the case of a teen who resented his mother’s “nagging” him about his blood tests. He responded by not doing them. Since in Type-1 diabetes, the necessary dosage of insulin can fluctuate dramatically, frequent blood tests are critical. Through the skills training, the young man was able to find a way of taking control over the situation: He agreed to keep track of his blood tests for several days, after which he would report them to his mother. He is not doing a perfect job of scheduling his blood tests but is much improved.

“Parents are reluctant to give up managing their kids’ diabetes because they don’t think the kids are responsible enough to do what they have to do,” said Grey. But she added that these adolescents will soon be young adults, living on their own, who will need some experience in maintaining their own health.

After six months, the researchers found such dramatic improvement in the group receiving skills training that they felt ethically compelled to offer the training to the control group as well.

“This is a relatively inexpensive, brief intervention that has real potential to help adolescents,” said Grey.