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Original Research|Articles in Press

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

Published:August 31, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.08.007
Assessing Incorporation of Type 1 Diabetes into Identity: Validation of the Accepting Diabetes And Personal Treatment (ADAPT) Survey in Teens and Young Adults
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      Abstract

      Objective

      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 (ages 13-25) with T1D (46% male, 87% White, 72% pump users, 67% CGM users, age 18.5±3.2 years, diabetes duration 10.2±5.0 years, HbA1c 8.5±1.3% (69±14 mmol/mol)). HbA1c 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 (ɑ=0.90) as well as criterion and construct validity. Greater incorporation of diabetes was associated with male sex, pump use, CGM use, lower HbA1c, less fear of hypoglycemia, less diabetes distress, and higher quality of life (ps<0.01). Factor analysis identified three 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, interference, and benefit-finding) offer targets for clinical intervention.

      Keywords

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      Article Info

      Publication History

      Accepted: August 24, 2022
      Received in revised form: July 14, 2022
      Received: March 24, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Key Messages:

      •Identity exploration is a hallmark of adolescence and young adulthood that can come into conflict with type 1 diabetes (T1D) management.

      •Incorporation of T1D into one’s identity has positive effects on biomedical and psychosocial outcomes.

      •The ADAPT survey assesses incorporation of T1D in identity and offers clinically meaningful opportunities to enhance incorporation.

      ACKNOWLEDGEMENTS

      Funding/Financial Support

      This research was supported by National Institutes of Health grants DP3DK113511, DP3DK104057, T32DK007260, and P30DK036836; the Katherine Adler Astrove Youth Education Fund; the Maria Griffin Drury Pediatric Fund; the Eleanor Chesterman Beatson Fund; and The Michael and Rosemary Ryan Pediatric Diabetes Research Fund. The content is solely the responsibility of the authors and does not necessarily represent the official views of these organizations.

      Conflict of Interest

      S.A.W. receives speaker fees from Abbott Diabetes, Insulet, and Dexcom, and receives grant support (to his institution) from Abbott Diabetes. E.D. is currently an employee and shareholder of Eli Lilly and Company. The work presented in this paper was performed as part of E.D.’s academic appointment and is independent of his employment with Eli Lilly and Company. L.M.L. is a consultant/advisor to Dexcom, Insulet, Medtronic, and Roche. P.V.C. and L.K.V. report no conflicts of interest.

      Author Contributions

      P.V.C. trained study staff in data collection, analyzed and interpreted the data, and wrote the first draft of the manuscript. L.K.V. analyzed the data, and edited the manuscript. S.A.W. conceptualized, designed, and implemented the study, interpreted the data, and edited the manuscript. E.D. conceptualized and designed the study, interpreted the data, and edited the manuscript. L.M.L. conceptualized, designed, and implemented the study; interpreted the data; and edited the manuscript. P.V.C. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have approved the manuscript.

      Prior Presentation and Publication

      Parts of this study were presented at the 79th Annual Scientific Sessions of the American Diabetes Association in San Francisco, CA in June 2019.

      Identification

      DOI: https://doi.org/10.1016/j.jcjd.2022.08.007

      Copyright

      © 2022 Canadian Diabetes Association.

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