Initial findings: primary diabetes care responsibility among emerging adults with type 1 diabetes post high school and move out of parental home

Emerging adults with type 1 diabetes are assuming primary diabetes care responsibility (Wolpert, Anderson, & Weissberg-Benchell, 2009), graduating from high school (Aseltine & Gore, 1993) and leaving their parents’ home (Furstenberg Jr., Rumbaut, & Settersten Jr., 2005). Living independently of parents occurs for up to 56% of emerging adults in general (Goldscheider, 1997; Arnett, 2003) and a similar portion (52%) of those with diabetes (Tebbi et al., 1990). When considering that many youth move in and out or parental homes (Arnett, 2000), even more (90%) of emerging adults live independently of parents for at least a 4-month period of time (de Marco & Berzin, 2008). Difficulties with these transitions place these young people’s health at risk. Glycemic control, essential for decreasing serious health consequences of diabetes (Diabetes Control and Complications Trial Research Group, 1994), is known to be poor among 18 to 19 year olds with diabetes (Bryden et al., 2001; Insabella, et al., 2007). These transitions are particularly important because assuming diabetes care responsibility is essential as emerging adults become more independent. Diabetes care responsibility is well known to increase over the adolescent years (Cameron et al., 2008; Hanna & Guthrie, 2003; Holmes et al., 2006; Ingerski et al., 2010; Ott et al., 2000; Palmer et al., 2004); to vary in degree of responsibility for different tasks (Anderson et al., 1990) and to involve several domains conceptualized as diabetes regimen, general health, and social presentation (Anderson et al; 1990); daily and non-daily management (Hanna & Guthrie, 2003); and direct or indirect management (Vesco et al., 2010). However, little is known about how responsibility, including certain aspects, changes for emerging adults as they graduate from high school and enter this developmental period of emerging adulthood (Arnett, 2007). Assumption of diabetes care responsibility by youth is noted to be associated with their readiness (Hanna & Decker, 2010) and key personal characteristics may be particularly important as they become more independent and reliant on their own resources. A specific area of readiness for emerging adults is their diabetes self-efficacy; among adolescents, it is associated with more responsibility (Holmes et al., 2006) and mediates the relationship between responsibility and management (Ott et al., 2000). In contrast, low self efficacy reflects a lack of readiness because for adolescents with low self-efficacy, there was greater parent-adolescent sharing of responsibility (Helgeson et al., 2008; Iannotti et al., 2006) and better diabetes outcomes when parents were responsible (Palmer et al., 2009). Another area of readiness is worry about hypoglycemia because those with greater worry would be concerned about having ready access to parents who have provided assistance with hypoglycemic events. Up to 40% of children and adolescents in a given year are estimated to require assistance with hypoglycemia by another person (Aman, Karlsson, & Wranne, 1989; Limbert et al., 1993; Nordfeldt et al., 2003; Nordfeldt & Ludvigsson, 1997). Gender needs to be considered in relationship to these variables because females have greater maturity and self-reliance (Palmer et al., 2004; Pacaud et al., 2007) and hypoglycemic worries (Gonder-Frederick et al., 2006). In addition, diabetes control needs to be considered because greater responsibility is associated with poorer glycemic control among younger adolescents (Helgeson et al., 2008); however, it is not known if this relationship exists for the older age group of emerging adults. Although little is known about these transitions for emerging adults with diabetes, these events are particularly important because assuming diabetes care responsibility is essential as they become more independent. Further, little information exists on the association of diabetes self-efficacy, worry about hypoglycemia, gender, and glycemic control with diabetes care responsibility among emerging adults with diabetes. Therefore, we examined (1) how diabetes care responsibility changed in relation to time (high school to post high school) and living situation (living independently or not of parents) and (2) the association of diabetes self-efficacy, worry about hypoglycemia, gender and glycemic control with changes in diabetes care responsibility among emerging adults with type 1 diabetes. Findings would provide insight for health care professionals preparing emerging adolescents during this transitional period and for those who plan to transition to independent living.