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Assessing Incorporation of Type 1 Diabetes Into Identity: Validation of the Accepting Diabetes And Personal Treatment Survey in Teens and Young Adults

Published:August 31, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.08.007

      Abstract

      Objectives

      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.

      Résumé

      Objectifs

      Les adolescents et les jeunes adultes atteints du diabète de type 1 (DT1) démontrent souvent de la difficulté à prendre en charge leur diabète, et ont du mal à composer avec les répercussions du DT1 sur leurs identités (image de soi, corps, réseaux sociaux, expériences de vie et situation future souhaitée). L’intégration positive du DT1 à l’identité peut bénéficier aux résultats biomédicaux et psychosociaux. Notre objectif était de valider et d’évaluer les propriétés psychométriques de l’enquête Accepting Diabetes And Personal Treatment (ADAPT), une nouvelle mesure de l’intégration du DT1 à son identité.

      Méthodes

      Cette étude transversale comptait 165 adolescents et jeunes adultes (de 13 à 25 ans) atteints du DT1 (46 % de sexe masculin, 87 % de Blancs, 72 % d’utilisateurs de pompes, 67 % effectuant la surveillance de la glycémie en continu [SGC], âgés de 18,5 ± 3,2 ans, durée du diabète de 10,2 ± 5,0 ans, hémoglobine glyquée [A1c] 8,5 ± 1,3 % [69 ± 14 mmol/mol]). Les données sur l’A1c ont été recueillies dans les dossiers médicaux; les participants ont rempli l’enquête ADAPT et les mesures validées de la crainte de l’hypoglycémie, de la détresse liée au diabète et de la qualité de vie. Nous avons évalué la cohérence interne, la fiabilité, la validité et la structure factorielle sous-jacente.

      Résultats

      L’enquête ADAPT à 18 questions a démontré une excellente cohérence interne (alpha = 0,90) ainsi que des validités critérielle et conceptuelle. Nous avons associé une plus grande intégration du diabète au sexe masculin, à l’utilisation de la pompe, à la SGC, à une plus faible A1c, à une crainte moins importante de l’hypoglycémie, à une détresse moins importante liée au diabète et à une meilleure qualité de vie (p < 0,01 pour tous). L’analyse factorielle a permis de cerner les 3 principaux facteurs qui contribuent à l’intégration : la prise en charge de la stigmatisation, l’ajustement à l’interférence perçue et la constatation des bénéfices secondaires.

      Conclusions

      L’enquête ADAPT est une mesure valide et fiable de l’intégration, chez les adolescents et les jeunes adultes atteints du DT1, qui montre l’importance de l’identité dans les résultats cliniques. L’utilisation de dispositifs pour le diabète et les facteurs liés à l’intégration (prise en charge de la stigmatisation, l’ajustement à l’interférence perçue et la constatation des bénéfices secondaires) offrent des cibles d’intervention clinique.

      Keywords

      Mots clés

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