The relationship among independence, diet adherence, and ego identity in adolescents with insulin-dependent diabetes mellitus

Diet adherence is an important aspect of diabetes management which contributes to metabolic control of the illness. However, adolescents have been shown to have low levels of adherence. The purpose of this study was to investigate the impact of autonomy, which accelerates during adolescence, on diet adherence. Independence in general aspects of life and in terms of managing their own diet regimens were considered. Ego identity development was also included in the present study as a possible mediator and/or moderator the relationship between independence and adherence. Subjects were recruited from an outpatient pediatric diabetes clinic. The sample of 69 adolescents with insulin-dependent diabetes mellitus completed paper-and-pencil questionnaires measuring general independence, independence in diet management, and ego identity development. Each subject also participated in three 24-hour diet recalls to measure adherence to professional diet recommendations. Results indicated that in general, the more autonomy subjects had in their daily lives (choosing their own friends, having as much freedom as they think they deserve, etc.), the better the quality of their diets. However, subjects levels of ego identity development appeared to affect how independence in diet management related to diet quality. For subjects who had more developed ego identities, more responsibility in their own diet management had a positive impact on diet adherence. On the other hand, subjects with less developed ego identities do not appear to be ready to manage their diets independently, and have better diets when their parents are more involved in choosing their foods. Overall, subjects further along in their ego identity development have better diet adherence, regardless of independence issues. Implications of the current research study are that adolescents with IDDM should be encouraged to obtain developmentally appropriate independence in their lives, as it is beneficial to their diabetes management as well as to their psychological growth. In terms of independence in diet management, indicators of psychological maturity should be considered when making decisions regarding how involved parents should be. It should be kept in mind, by both parents and health care providers, that psychological growth is important to good diabetes management