The Role of Peers for Diabetes Management in Adolescents and Emerging Adults with Type 1 Diabetes: A Longitudinal Study

Background

The social context of youth with type 1 diabetes plays an important role in the adjustment to the disease. Multiple studies have investigated the role of parents for diabetes management and well-being in adolescents and emerging adults. Just like parents, peers also constitute an important part of youth’s social context. However, despite that the increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged, longitudinal research linking the peer context to diabetes management and outcomes is scarce. Further, previous type 1 diabetes studies mainly focused on peer support at the expense of more negative indicators of the peer context. One such indicator that can be particularly relevant in this respect is extreme peer orientation. Extreme peer orientation refers to the degree to which fitting in with peers is valued more than performing important age-specific tasks (e.g., performing academically) and managing one’s diabetes. Thus, the present longitudinal study in a large sample of youth with type 1 diabetes related both positive and negative indicators of the parent and peer context to diabetes outcomes over a time interval of one year.

Method

Our sample consisted of 467 adolescents (14-17 years) and emerging adults (18-25 years) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-specific distress (with subdomains food, treatment, and emotional distress), and treatment adherence. As a physiological indicator of how well patients have their diabetes under control (i.e. glycemic control), HbA1c-values were obtained from patients’ treating physicians. Higher HbA1c-values indicate worse glycemic control. Cross-lagged analysis from a structural equation modelling approach was performed to assess directionality of effects.

Results

Peer support at T1 predicted relative decreases in emotional, food, and treatment distress at T2. In addition, parental responsiveness predicted relative decreases in food distress at T2. Furthermore, extreme peer orientation at T1 predicted relative increases in treatment distress at T2. Finally, treatment adherence at T1 predicted relative decreases in extreme peer orientation, treatment distress, and HbA1c-values at T2. Multigroup analyses indicated that some cross-lagged paths were moderated by age. For emerging adults specifically, there was a reciprocal relationship between HbA1c-values and extreme peer orientation, as they positively predicted each other. These prospective associations were not significant in adolescents.

Conclusion

The finding that peer support negatively predicted diabetes-specific distress on top of parental responsiveness, highlights the importance of peers for the functioning of youth with type 1 diabetes. Further, an undesirable reciprocal relationship between extreme peer orientation and HbA1c-values was obtained for emerging adults and not for adolescents, possibly because adolescents are monitored more intensively by their parents. Hence, it seems important, as a parent or clinician, to monitor emerging adults with problematic peer relationships to avoid problems with diabetes functioning. In sum, the present study underscores the importance of the peer context for adolescents and emerging adults with type 1 diabetes.

Contact: koen.raymaekers@kuleuven.be

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