Illness representations predict adherence in adolescents and young adults with type 1 diabetes

Objective: Most adolescents and young adults (AYAs) with type 1 diabetes struggle with diabetes self-management and exhibit suboptimal glycemic control. This study examined two models of association between illness representations, a modifiable predictor of suboptimal outcomes, and adherence and glycemic control in AYAs with type 1 diabetes. Design and main outcome measures: Ninety-nine AYAs (ages 15-20 years) completed measures of illness representations and adherence at two visits. Blood glucose monitoring frequency and haemoglobin A1c were obtained via chart review. Relationships were examined using structural equation modelling. Results: Illness representations accounted for a significant proportion of the variance in blood glucose monitoring frequency (Delta R-2 = .23, p < .01) and adherence to emergency precautions at Time 1 (Delta R-2 = .07, p = .03). Illness representations also accounted for significant variance in blood glucose monitoring frequency (Delta R-2 = .08, p = .01), adherence to recommendations for insulin and food (Delta R-2 =.08, p = .02) and exercise (Delta R-2 = .10, p < .01), and adherence to emergency precautions (Delta R-2 = .16, p < .01) at Time 2. Conclusion: Illness representations are salient predictors of adherence in this population. Interventions targeting adherence promotion and glycemic control in AYAs with type 1 diabetes may be enhanced by efforts to modify illness representations.