目的:患有1型糖尿病(T1D)的青少年通常表现出糖尿病管理困难,当他们努力驾驭T1D对他们的身份——他们的自我概念的影响时,机构,社交网络,生活经验和期望的未来。将T1D积极纳入身份可能有利于生物医学和社会心理结果。我们旨在验证和评估接受糖尿病和个人治疗(ADAPT)调查的心理测量特性,一种将T1D纳入一个人身份的新方法。
方法:这项横断面研究包括165名患有T1D的青少年和年轻人(13至25岁)(46%为男性,87%高加索人,72%的泵用户,67%的连续血糖监测[CGM],年龄18.5±3.2岁,糖尿病病程10.2±5.0年,糖化血红蛋白[A1C]8.5±1.3%[69±14mmol/mol])。从医疗记录中收集A1C;参与者完成了ADAPT调查并验证了对低血糖的恐惧措施,糖尿病困扰和生活质量。内部一致性,可靠性,评估了效度和潜在因素结构。
结果:18项ADAPT调查显示出优异的内部一致性(α=0.90)以及标准和结构效度。糖尿病的增加与男性有关,泵使用,CGM使用,降低A1C,减少对低血糖的恐惧,减少糖尿病困扰,提高生活质量(P<0.01)。因素分析确定了合并的3个主要贡献者:污名管理,对感知干扰和利益发现的调整。
结论:ADAPT调查是一种有效和可靠的纳入青少年和青少年T1D的措施,突出了身份在健康结果中的重要性。糖尿病设备的使用和合并因素(耻辱管理,对感知干扰和利益发现的调整)为临床干预提供了目标。
OBJECTIVE: Teens and young adults with type 1 diabetes (T1D) often demonstrate difficulty with diabetes management, as they struggle to navigate the impact of T1D on their identities---their self-concepts, bodies, social networks, life experiences and desired futures. Positively incorporating T1D into identity may benefit biomedical and psychosocial outcomes. We aimed to validate and assess psychometric properties of the Accepting Diabetes and Personal Treatment (ADAPT) survey, a new measure of incorporation of T1D into one\'s identity.
METHODS: This cross-sectional study included 165 teens and young adults (13 to 25 years of age) with T1D (46% male, 87% Caucasian, 72% pump users, 67% on continuous glucose monitoring [CGM], age 18.5±3.2 years, diabetes duration 10.2±5.0 years, glycated hemoglobin [A1C] 8.5±1.3% [69±14 mmol/mol]). A1C was collected from medical records; participants completed the ADAPT survey and validated measures of fear of hypoglycemia, diabetes distress and quality of life. Internal consistency, reliability, validity and underlying factor structure were assessed.
RESULTS: The 18-item ADAPT survey demonstrated excellent internal consistency (alpha=0.90) as well as criterion and construct validity. Greater incorporation of diabetes was associated with male sex, pump use, CGM use, lower A1C, less fear of hypoglycemia, less diabetes distress and improved quality of life (p<0.01 for all). Factor analysis identified 3 main contributors to incorporation: Stigma Management, Adjustment to Perceived Interference and Benefit-finding.
CONCLUSIONS: The ADAPT survey is a valid and reliable measure of incorporation in teens and young adults with T1D that highlights the importance of identity in health outcomes. Diabetes device use and factors of incorporation (Stigma Management, Adjustment to Perceived Interference and Benefit-finding) offer targets for clinical intervention.