READY (REgulating Adherence to Diabetes as Young adults)
In 2011, we received a 5-year NIH grant to study how adolescents with type 1 diabetes transition into emerging adulthood and the ways that parents may assist in that transition. Late adolescence and emerging adulthood (ages 18+) pose challenges for adherence to the diabetes regimen (move out of home, move from the pediatric care system). READY was a longitudinal observational study involving 250 adolescents with type 1 diabetes at two sites (Utah and Texas). They were recruited in their senior year of high school and assessed annually for four years, with a daily diary assessment in year 1.
Some important findings from our study include:
- Those with higher executive function experience a less rapid deterioration in HbA1c across emerging adulthood, placing them at lower risk for early complications of the disease (Berg et al., 2018).
- Those with higher executive function have better diabetes outcomes as they experience fewer daily self-regulation failures assessed via diaries (Berg et al., 2014).
- Those with higher executive function are also better able to plan and exert effort toward their weekly diabetes goals. (Wiebe et al., 2018).
- Emerging adults who engage their social support system by disclosing to parents challenges with diabetes management experience better daily adherence (Berg et al., 2016) and better HbA1c in the years after high school (Kelly, Berg et al., in press).
DIADIC – DIabetes Across Development In Couples
In 2014 we received a 5-year grant from NIH to examine how adults cope with type 1 diabetes across the adult life span. As coping with diabetes occurs in a social context, romantic partners likely play an important role in diabetes management. However, little was known about how adults cope with type 1 diabetes management throughout adulthood and the role of romantic partners. The study employed a multi-method, multisite, design and examined collaborative and supportive strategies, stress, diabetes management, and distress. Two-hundred and fifty couples across the life span where one person had type 1 diabetes across two sites (UT and PA) completed a baseline interview, a 14-day daily diary, and a conflict discussion task.
We are in the process of analyzing data and writing up the results. So far we have found:
- Individuals with type 1 diabetes who view their illness as more shared with their partner are more likely to benefit from collaborative and supportive strategies from their spouse in terms of reductions in stress and better physical functioning (Helgeson et al., 2019).
- Older adults report fewer stressful events than young adults with their diabetes management and yet the daily stressors they experience are quite similar.
- Patients in older couples underestimate the impact of diabetes on their spouse’s daily lives and older couples must adapt to the changing nature of diabetes over the life span (Litchman et al, 2019).
- Daily shared illness appraisal predicts greater collaborative and supportive strategies and shared appraisal is more predictive of better self-regulation and self-care than collaboration.
- The use of relational language as couples discuss diabetes management is linked to more positive health outcomes for couples as it facilitates collaborative and supportive processes (Lee et al., in press).
FAMS (Family/Friend Activation to Motivate Self-Care)
Together with Dr. Lindsay Mayberry (PI) I have assisted in developing an intervention to improve individuals’ utilization of their social network for type 2 diabetes management. The intervention combines:
- Text messaging to facilitate goal setting and social support,
- Phone coaching to improve meeting goals and skills to manage social relationships, and
- Text messages to a support person to facilitate dialogue and support for diabetes.
- FAMS is most effective when individuals with type 2 diabetes are enrolled with a support person. (Mayberry, Berg, Harper, & Osborn, 2016)
- We have designed a tool to assess helpful and harmful family and friend involvement in adults’ type 2 diabetes. (Mayberry, Berg, Greevy, & Wallston, 2019)
We are modifying the FAMS intervention and piloting the project with emerging adults with type 1 diabetes.
We are enrolling for a study of families where multiple members have type 1 diabetes. We are examining how having one individual in the family already diagnosed with type 1 diabetes may provide resources for families as well as hold challenges for providing multiple members with support.
If you are interested in participating, please contact Jessica.Mansfield@psych.utah.edu.