Early Risk Factors for Nonadherence in Pediatric Type 1 Diabetes: A Review of the Recent Literature

David      D. Schwartz; Virginia      D. Cline; Jennifer      A. Hansen; Marni      E. Axelrad; Barbara      J. Anderson

Abstract

Nonadherence to different aspects of the diabetes regimen is common. Problems early in the course of illness predict later difficulties with nonadherence; conversely, good management early on protects against later complications. Screening for early risk factors at the time of diabetes diagnosis is therefore critical for promoting the health of children with type 1 diabetes. The purpose of this paper is to review and synthesize the recent empirical literature on early risk factors for nonadherence in type 1 diabetes, with a focus on three specific adherence behaviors: insulin administration, blood glucose monitoring, and clinic attendance. Risk factors are considered within several broad categories: sociodemographic barriers that limit access to care; child and parent factors that affect adherence both directly and indirectly via their impact on the development of family teamwork; and family interactions with their health-care providers. We integrate the different findings into a “simple model” that can be used to develop efficient screening protocols that can in turn guide efforts at preventive intervention.

Keywords: Type 1 Diabetes, Nonadherence, Risk Factors, Children, Adolescents, Review