Improving outcomes for young people with type 1 diabetes

Aims: The thesis aimed to contribute to the current understanding of how to improve comprehensive health outcomes for children and adolescents with type 1 diabetes. Methods: A systematic review was undertaken to identify existing interventions designed to improve health-related quality of life in a paediatric diabetes population. The quality of identified studies was assessed and the effectiveness of the interventions was evaluated. Parent-adolescent dyads were also recruited via paediatric diabetes teams to participate in an empirical study. Participants were asked to complete questionnaires measuring psychological flexibility, mindfulness, perception of parental care and control, adherence to treatment and quality of life. Relationships were explored using correlation and regression analysis. Results: Twenty seven articles were identified in the systematic review. More than half were rated as “acceptable” or “high quality”. Quality of life was a primary treatment target in only three studies. Eight studies reported significant beneficial effects on health-related quality of life. In the empirical study, regression analysis found that both parent and adolescent diabetes-specific psychological flexibility predicted treatment adherence while adolescent mindfulness and insulin administration predicted quality of life. Conclusion: There is some evidence for the effectiveness of intensive structured education and coping skills training in improving health-related quality. However consideration should be given to developing theoretically informed interventions to target quality of life alongside other treatment related outcomes. The empirical study suggested psychological flexibility and mindfulness are useful constructs for understanding health outcomes in adolescents with type 1 diabetes. Acceptance and commitment, and mindfulness-based therapies may prove beneficial for improving outcomes in this population