Adherence Behaviors and Health Status in Childhood Diabetes

  • Suzanne Bennett Johnson
Part of the Contributions to Psychology and Medicine book series (CONTRIBUTIONS)


Defining adherence to the diabetes regimen is difficult for several reasons. First, there is the vast array of regimen behaviors required. Insulin injections must be given at regular times and appropriately timed in relationship to meals. Dietary proscriptions are numerous; small meals must be taken frequently and certain types of foods, those high in concentrated sweets and fats, are to be minimized. Regular exercise is considered beneficial as it improves insulin utilization and lowers blood glucose, but it must be carefully coordinated with food intake so as to avoid hypoglycemia. Since current treatment methods only approximate normal pancreatic function, wide swings in blood glucose can and do occur. For this reason, patients are encouraged to test their blood glucose two or more times a day. These data are then utilized by the physician and/or patient to make insulin dose, dietary, or other changes to the patient’ s daily regimen. Consequently, defining adherence in childhood diabetes means defining numerous regimen behaviors.


Blood Glucose Insulin Dose Dietary Behavior Childhood Diabetes Adherence Measure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Amiel, S.A., Sherwin, R.S., Simonson, D.C., Lauritano, A.A., & Tamborlane, W.V. (1986). Impaired insulin action in puberty: A contributing factor to poor glycemic control in adolescents with diabetes. The New England Journal of Medicine, 315, 215–219.PubMedCrossRefGoogle Scholar
  2. Barrett-Connor, E., & Orchard, T. (1985). Diabetes and heart disease. In National Diabetes Data Group (Eds.). Diabetes in America(pp. XVI: 1–41) (NIH Publication No. 85 –1468 ). Washington, D.C.: U.S. Department of Health and Human Services/Public Health Service.Google Scholar
  3. Bobrow, E.S., AvRuskin, T.W., & Siller, J. (1985). Mother-daughter interaction and adherence to diabetes regimens. Diabetes Care, 8, 146–151.PubMedCrossRefGoogle Scholar
  4. Brownlee-Duffeck, M. Peterson, L., Simonds, J.F., Goldstein, D., Kilo, C., & Hoette, S. (1987). The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus. Journal of Consulting and Clinical Psychology, 55, 139–144.PubMedCrossRefGoogle Scholar
  5. Carney, R.M., Schecter, K., & Davis, T. (1983). Improving adherence to blood glucose testing in insulin-dependent diabetic children. Behavior Therapy, 14, 247–254.CrossRefGoogle Scholar
  6. Caron, H.S., & Roth, H.P. (1968). Patients’ cooperation with a medical regimen: Difficulties in identifying the noncooperator. The Journal of the American Medical Association, 203, 120–124.CrossRefGoogle Scholar
  7. Charney, E., Bynum, R., Eldredge, D., Frank, D., MacWhinney, J.B., McNabb, N., Scheiner, A., Sumpter, E.A., & Iker, H. (1967). How well do patients take oral penicillin? A collaborative study in private practice. Pediatrics, 40, 188–195.PubMedGoogle Scholar
  8. Christensen, N.K., Terry, R.D., Wyatt, S., Pichert, J.W., & Lorenz, R.A. (1983). Quantitative assessment of dietary adherence in patients with insulin-dependent diabetes mellitus. Diabetes Care, 6, 245–250.PubMedCrossRefGoogle Scholar
  9. Clarke, W.L., Snyder, A.L., & Nowacek, G. (1985). Outpatient pediatric diabetes-I. Current practices. Journal of Chronic Diseases, 38, 85–90.PubMedCrossRefGoogle Scholar
  10. Cox, D.J., Gonder-Frederick, L., Pohl, S., & Pennebaker, J.W. (1983). Reliability of symptom-blood glucose relationships among insulin-dependent adult diabetics. Psychosomatic Medicine, 45, 357–360.PubMedGoogle Scholar
  11. Cox, D.J., Taylor, A.G., Nowacek, G., Holley-Wilcox, P., & Pohl, S.L. (1984). The relationship between psychological stress and insulin-dependent diabetic blood glucose control: Preliminary investigations. Health Psychology, 3, 63–75.PubMedCrossRefGoogle Scholar
  12. Daneman, D., Siminerio, L., Transue, D., Betschart, J., Drash, A., & Becker, D. The role of self-monitoring of blood glucose in the routine management of children with insulin-dependent diabetes mellitus. Diabetes Care, 8 1–4.PubMedCrossRefGoogle Scholar
  13. Davis, M.S. (1968). Physiologic, psychological and demographic factors in patient compliance with doctors’ orders. Medical Care, 6, 115–122.CrossRefGoogle Scholar
  14. Epstein, L.H., Beck, S., Figueroa, J., Farkas, G., Kazdin, A.E., Daneman, D., & Becker, D. (1981). The effects of targeting improvements in urine glucose on metabolic control in children with insulin dependent diabetes. Journal of Applied Behavior Analysis, 14, 365–375.PubMedCrossRefGoogle Scholar
  15. Epstein, L.H., & Cluss, P.A. (1982). A behavioral medicine perspective on adherence to long-term medical regimens. Journal of Consulting and Clinical Psychology, 50, 950–971.PubMedCrossRefGoogle Scholar
  16. Epstein, L.H., Coburn, P.C., Becker, D., Drash, A., & Siminerio, L. (1980). Measurement and modification of the accuracy of determinations of urine glucose concentration. Diabetes Care, 3, 535–536.PubMedCrossRefGoogle Scholar
  17. Freund, A., Johnson, S.B., Rosenbloom, A., Alexander, B., & Hansen, C.A. (1986). Subjective symptoms, blood glucose estimation, and blood glucose concentrations in adolescents with diabetes. Diabetes Care, 9, 236–243.PubMedCrossRefGoogle Scholar
  18. Freund, A., Johnson, S.B., Silverstein, J., & Thomas, J. (1989). Assessing daily management of childhood diabetes using 24-hr. recall interviews: Reliability and stability. Unpublished manuscript, University of Florida.Google Scholar
  19. Glasgow, A.M., August, G.P., & Hung, W. (1981). Relationship between control and serum lipids in juvenile-onset diabetes. Diabetes Care, 4, 76–80.PubMedCrossRefGoogle Scholar
  20. Glasgow, R.E., McCaul, K.D., & Schafer, L.C. (1987). Self-care behaviors and glycemic control in type I diabetes. Journal of Chronic Disease, 40, 399–417.CrossRefGoogle Scholar
  21. Glasgow, R.E., Wilson, W., & McCaul, K.D. (1985). Regimen adherence: A problematic construct in diabetes research. Diabetes Care, 8, 300–301.PubMedGoogle Scholar
  22. Gonder-Frederick, L.A., Julian, D.M., Cox, D.J., Clarke, W.L., & Carter, W.R. (1988). Self-measurement of blood glucose: Accuracy of self-reported data and adherence to recommended regimen. Diabetes Care, 11, 579–585.PubMedCrossRefGoogle Scholar
  23. Gross, A.M. (1983). Self-management training and medication compliance in children with diabetes. Child and Family Behavior Therapy, 4, 47–55.CrossRefGoogle Scholar
  24. Hanson, C.L., Henggeler, S.W., & Burghen, G.A. (1987a). Race and sex differences in metabolic control of adolescents with IDDM: A function of psychosocial variables? Diabetes Care, 10, 313–318.CrossRefGoogle Scholar
  25. Hanson, C.L., Henggeler, S.W., & Burghen, G.A. (1987b). Model of associations between psychosocial variables and health-outcome measures of adolescents with IDDM. Diabetes Care, 10, 752 – 758.CrossRefGoogle Scholar
  26. Hulka, B.S., Kupper, L.L., Cassel, J.C., & Mayo, F. (1975). Doctor-patient communication and outcomes among diabetic patients. Journal of Community Health, 1, 15–27.PubMedCrossRefGoogle Scholar
  27. Johnson, S.B., Freund, A., Silverstein, J., Hansen, C., & Malone, J., (1989). Adherence/health status relationships in childhood diabetes. Unpublished manuscript, University of Florida.Google Scholar
  28. Johnson, S.B., Pollak, T., Silverstein, J.H., Rosenbloom, A.L., Spillar, R., McCallum, M., & Harkavy, J. (1982). Cognitive and behavioral knowledge about insulin dependent diabetes among children and parents. Pediatrics, 69, 708–713.PubMedGoogle Scholar
  29. Johnson, S.B., Silverstein, J., Rosenbloom, A., Carter, R., & Cunningham, W. (1986). Assessing daily management in childhood diabetes. Health Psychology, 5, 545–564.PubMedCrossRefGoogle Scholar
  30. Johnson, S.B., Silverstein, J., Rosenbloom, A., Carter, R., & Cunningham, W. (1986). Assessing daily management in childhood diabetes. Health Psychology, 5, 545 – 564.PubMedCrossRefGoogle Scholar
  31. Kaplan, R.M., Chadwick, M.W., & Schimmel, L.E. (1985). Social learning intervention to promote metabolic control in type I diabetes mellitus: Pilot experiment results. Diabetes Care, 8, 107–206.CrossRefGoogle Scholar
  32. Kaar, M.-L., Akerblom, H.K., Huttunen, N.-P., Knip, M., & Sakkinen, K. (1984). Metabolic control in children and adolescents with insulin-dependent diabetes mellitus. Acta Paediatrica Scandinavica, 73, 102–108.PubMedCrossRefGoogle Scholar
  33. Lopes-Virella, M.F., Wohlthmann, H.J., Loadholt, C.B., & Buse, M.G. (1981). Plasma lipids and lipoproteins in young insulin-dependent diabetic patients: Relationship with control. Diabetologia, 21, 216–223.PubMedCrossRefGoogle Scholar
  34. Lowe, K., & Lutzker, J.R. (1979). Increasing compliance to a medical regimen with a juvenile diabetic. Behavior Therapy, 10, 57–64.CrossRefGoogle Scholar
  35. Marquis, K.H., Ware, J.E., Jr., & Relies, D.A. (1979). Measures of diabetic patient knowledge, attitudes and behavior regarding self-care: Summary Report Atlanta, GA: Center for Disease Control (NTIS No. PB83-134528).Google Scholar
  36. Mazze, R.S., Pasmantier, R., Murphy, J., & Shamoon, H. (1985). Self-monitoring of capillary blood glucose: Changing the performance of individuals with diabetes. Diabetes Care, 8, 207–213PubMedCrossRefGoogle Scholar
  37. Page, P., Verstraete, D.G., Robb, J.R., & Etzwiler, D.D. (1981). Patient recall of self-care recommendations in diabetes. Diabetes Care, 4, 96–98.PubMedCrossRefGoogle Scholar
  38. Pennebaker, J.W., Cox, D.J., Gonder-Frederick, L., Wunsch, M.G., Evans, W.C., & Pohl, S. (1981). Physical symptoms related to blood glucose in insulin-dependent diabetics. Psychosomatic Medicine, 43, 489–500.PubMedGoogle Scholar
  39. Peterson, C.M., Koenig, R.J., Jones, R.L., Saudek, C.D., & Cerami, A. (1977). Correlation of serum triglyceride levels and hemoglobin concentrations in diabetes mellitus. Diabetes, 26, 507–509.PubMedCrossRefGoogle Scholar
  40. Reynolds, L., Johnson, S.B., and Silverstein, J. (in press). Assessing daily diabetes management by 24-hr. recall interview: The validity of children’ s reports. Journal of Pediatric Psychology.Google Scholar
  41. Schade, D.S., Santiago, J.V., Skyler, J.S., & Rizza, R.A. (1983). Intensive insulin therapy. Amsterdam: Excerpta Medica.Google Scholar
  42. Schafer, L.C., Glasgow, R.E., & McCaul, K.D. (1982). Increasing the adherence of diabetic adolescents. Journal of Behavioral Medicine, 5, 353–362.PubMedCrossRefGoogle Scholar
  43. Schafer, L.C., Glasgow, R.E., McCaul, K.D., & Dreher, M. (1983). Adherence to IDDM regimens: Relationship to psychosocial variables and metabolic control. Diabetes Care, 6, 493–498.PubMedCrossRefGoogle Scholar
  44. Schafer, L.C., McCaul, K.D., & Glasgow, R.E. (1986). Supportive and nonsupportive family behaviors: Relationships to adherence and metabolic control in persons with Type I diabetes. Diabetes Care, 9, 179–185.PubMedCrossRefGoogle Scholar
  45. Simonds, J., Goldstein, D., Walker, B., & Rawlings, S. (1981). The relationship between psychological factors and blood glucose regulation in insulin-dependent diabetic adolescents. Diabetes Care, 4, 610–615.PubMedCrossRefGoogle Scholar
  46. Sosenko, J.M., Breslow, J.L., Miettinen, O.S., & Gabbay, K.H. (1980). Hyperglycemia and plasma lipid levels: A prospective study of young insulin-dependent diabetic patients. New England Journal of Medicine, 302, 650–654.PubMedCrossRefGoogle Scholar
  47. Spevack, M. Johnson, S.B., & Riley, W. (1988). The effect of diabetes summer camp on adherence behaviors and glycemic control. Presented at the Florida Conference on Child Health Psychiology, Gainesville, Florida.Google Scholar
  48. Tattersall, R.B., & Lowe, J. (1981). Diabetes in adolescence. Diabetologia, 20, 517–523.PubMedCrossRefGoogle Scholar
  49. Travis, L.B., Brouhard, B.H., & Schreiner, B. (1987). Diabetes mellitus in children and adolescents. Philadelphia: W.B. Saunders Co.Google Scholar
  50. Watkins, J.D., Williams, F., Martin, D.A., Hogan, M.D., & Anderson, E. (1967). A study of diabetic patients at home. American Journal of Public Health, 57, 452–459.PubMedCrossRefGoogle Scholar
  51. Webb, K.L., Dobson, A.J., Tupling, H.E., Harris, G.W., O′Connell, D.L., Atkinson, J., Sulway, M.J., & Leeder, S.R. (1982). Evaluation of a diabetes education programme. Australian/New Zealand Journal of Medicine, 12, 153–160.CrossRefGoogle Scholar
  52. Webb, K.L., Dobson, A.J., O′Connell, D.L., Tupling, H.E., Harris, G.W., Moxon, J.A., Sulway, M.J., & Leeder, S.R. (1984). Dietary compliance among insulin-dependent diabetics. Journal of Chronic Disease, 37, 633–643.CrossRefGoogle Scholar
  53. Williams, T.F., Martin, D.A., Hogan, M.D., Watkins, J.D., & Ellis, E.V. (1967). The clinical picture of diabetic control, studied in four settings. American Journal of Public Health, 57, 441–451.PubMedCrossRefGoogle Scholar
  54. Wilson, D.P., & Endres, R.K. (1986). Compliance with blood glucose monitoring in children with Type I diabetes mellitus. The Journal of Pediatrics, 108, 1022–1024.PubMedCrossRefGoogle Scholar
  55. Wing, R., Nowalk, M., Marcus, M., Koeske, R., & Finegold, D. (1986). Subclinical eating disorders and glycemic control in adolescents with Type I diabetes. Diabetes Care, 9, 162–167.PubMedCrossRefGoogle Scholar
  56. Ziel, R.H., & Davidson, M.B. (1987). The role of glucosylated serum albumin in monitoring glycemic control in stable insulin-requiring diabetic out-pa tients. Journal of Clinical Endocrinology and Metabolism, 64, 269–273PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1990

Authors and Affiliations

  • Suzanne Bennett Johnson

There are no affiliations available

Personalised recommendations