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Show SPRING 2013 The Role of Peer Support and Conformity in Type 1 Diabetes Management During Adolescence Karen Y u \ Cynthia A. Berg, Ph.D', A m y Hughes, M.S.', Deborah Wiebe, Ph.D.2 1. University of Utah, Department of Psychology, 2. University of Texas Southwestern Medical Center £1 u THE UNIVERSITY OF UTAH ^TSOUIHWESTERN Introduction Background • 1 in 6X10-800 children are affected by Type 1 diabetes * Coal of diabetes management is lo mimic a functional pancreas. * Consequences of poor management * Hypo/hyperglyccmia * Neuropathy, kidney diseases, retinopathy, heart diseases • Peer support has been found to be beneficial in facilitating adherence behaviors and metabolic control during adolescence (UGTecaetal.,2002) * Peers may also apply pressure to adolescents lo engage in behaviors that are at odds with good diabetes management (Drew et al., 2009) Objectives • Examine how peer support and peer conformity relate to adherence and metabolic control during adolescence • Examine whether those Iwo influences gain importance as adolescents get older T w o separate multiple regressions were conducted to assess whether peer support and conformity predicted HbAlc values and adherence. Support Conformity Methods Participants * 198 adolescents with type 1 diabetes meltitus(Af age-1 5.03, range 12.56-17.72; 45.6% male) • 37.6% on multiple daily injections • Average 5.1 injections • Average 5.6 blood glucose tests per day * 62.4% using insulin pump ' Illness duration > 1 year (M=6.6 years) Measures •Metabolic Control via HbAlc •As part of the routine clinic visit, adolescents' glycosylated hemoglobin (HbAlc) levels were obtained; higher HbAlc means worse metabolic control •Self Care Inventory (La Greca, Follansbee, & Skyler, 1990) • 16-iterns assess adherence to various aspects of the diabetes regimen over the preceding month •Network of Relationships Inventory (Furman &. Buhrmesier, 1985) •Raited support i veness of the subject's best friend •E.g., H o w much do you turn to this person for comfort and support when you are troubled about something? •Extreme Peer Orientation Measure (EPO) •Evaluates how much adolescents are willing lo sacrifice positive development to gain peer acceptance •E.g., How much docs the time you spend with your friends keep you away from doing the things you ought to do to manage your More peer conformity i adbi Betas Support .09 Conformity -.27 N o significant interactions were found indicating any differences by age for the effects of peer support or peer conformity 1.18 1.46 t 1.24 -3.90 24 .15 " « • " - ' P 22 .000" Discussion Implications • Peers may have a negative effect on adhering to the diabetes regimen (diet, exercise, testing) when adolescents are willing to sacrifice diabetes management for peer acceptance • The negative effect of peer conformity seem to be more significant than the possible positive effect of peer support • This effect seem to be consistent across late adolescence. Limitations • The peer support scale may be too generalized to pinpoint peer support in adolescents with diabetes • The study did not address the possible effects from other types of influences. • E.g., family support Future Directions * Future studies should be conducted to address why neither E P O nor peer support were able to predict H b A 1 c values • Explore other dimensions of peer influence that may be more specific to diabetes Adherence Behavior Checking Blood Glucose Reading Food Labels Treating blood glucose Counting carbs Calculating insulin doses Eating proper foods Glucose recording Carrying quick acting sugars THE ROLE OF PEER SUPPORT AND CONFORMITY IN TYPE 1 DIABETES MANAGEMENT DURING ADOLESCENCE Karen Yu (Cynthia A. Berg) Department of Psychology University of Utah Existing literature has argued that peer support may be beneficial in facilitating adherence behaviors and metabolic control during adolescence (LaGreca et al., 1998). However, peers may also apply pressure to engage in behaviors that are at odds with good diabetes management (Drew et al., 2010). The present study examined how these two peer influences relate to adherence and metabolic control during adolescence and whether they become more important as adolescents are older. One-hundred ninety-eight adolescents (M age =15.03, range 12.56-17.72,45.6 % male) completed questionnaires. To assess friend support, adolescents completed the Network of Relationships Inventory and to assess how much adolescents were willing to sacrifice diabetes management to receive peer acceptance, the Extreme Peer Orientation Scale (EPO). Adherence was assessed via the Self-Care Inventory and HbA1 c was collected from medical records. Separate multiple regressions were conducted to examine whether peer support and extreme peer orientation predict adherence and metabolic control (HbAlc). When predicting adherence extreme peer orientation was a significant predictor (15= -.27, p< .01, t=-3.90), explaining 8 % of the variance in adherence (F(2,192)=8.00, p < .01). When adolescents reported being more willing to sacrifice diabetes management to conform to peers, adherence was lower. Neither EPO nor peer support were significant predictors of HbAI c (ps > .15). Interactions between age and extreme peer orientation and peer support were not significant for either model (ps > .12), indicating that age did not moderate these associations. During late adolescence, peers may have a negative effect on adhering to the diabetes regimen (diet, exercise, testing) when adolescents are willing to sacrifice diabetes management for peer acceptance. This effect seems to be consistent across late adolescence. Future studies should focus on addressing the question of why neither EPO nor peer support were able to predict HbA1 c (an indicator of metabolic control), and exploring other dimensions of peer influence that may be more specific to diabetes. 30 |