Exploring Self-Efficacy in the Current Era of Type 1 Diabetes Management in Youth

Type 1 diabetes is a chronic incurable autoimmune disease characterized by dysregulated carbohydrate metabolism. Nearly 3 million individuals in the United States with type 1 diabetes are challenged to meticulous self-management to avoid diabetes-related complications. Self-efficacy is an important construct associated with health behavior change that may be relevant for adherence to diabetes self-management tasks involving diabetes technologies, such as continuous glucose monitoring (CGM). Yet, there is a fundamental gap in understanding how self-efficacy relates to CGM use in youth with type 1 diabetes. This dissertation focuses on the behavior of CGM use in youth with type 1 diabetes as well as the relationship of self-efficacy and self-management adherence in the contemporary era of diabetes technologies. Specifically, the following research questions are addressed: (a) how do masked CGM and treatment recommendations following sensor wear affect glycemic control in a contemporary cohort of youth with type 1 diabetes, (b) what instruments are available to measure self-efficacy related to contemporary diabetes management in youth with type 1 diabetes and their caregivers, (c) how does self-efficacy, measured by a novel CGM Self-Efficacy instrument (CGM-SE), relate to CGM use and glycemic control in a cohort of youth with type 1 diabetes initiating CGM therapy. The conclusions from this research are that: (a) masked CGM offers opportunities to guide advanced insulin management and requires orchestration of the multidisciplinary diabetes team, particularly nurse educators, (b) an integrative review identified 10 different instruments to measure self-efficacy related to diabetes management with varying levels of reliability and validity, yet there is a deficit in available instruments to measure self-efficacy related to diabetes technologies such as CGM, (c) a novel CGM-SE instrument used in a contemporary cohort of youth with type 1 diabetes appears to have strong psychometric properties and demonstrated predictive validity as youth that reported higher baseline self-efficacy had significantly greater CGM wear and lower hemoglobin A1c (HbA1c) at 3 and 6 months compared to youth reporting lower self-efficacy. This body of work provides a greater understanding of the use of masked CGM technology, the concept of self-efficacy as it relates to youth with type 1 diabetes and their caregivers, and how to measure self-efficacy related to CGM use in a contemporary cohort of youth with type 1 diabetes. Importantly, this dissertation refines the relationship between self-efficacy and CGM use by establishing the utility of the CGM-SE instrument. Identifying elements, such as self-efficacy, that may promote and improve self-management behaviors is an important step towards improving diabetes outcomes and consistent use of CGM technology. This is especially relevant to diabetes nurse educators who play a critical role in supporting the self-management of youth with type 1 diabetes and their families