Abstract:
This dissertation had two objectives: A) determine the optimum diabetes selfmanagement
educational (DSME) interventions in improving health-related quality of
life (HRQoL) among adolescents with type 1 diabetes (T1D) and describe its
characteristics, and B) assess the HRQoL of adolescents with T1D using one self-rated
health (SRH) question and identify the most significant factors contributing to lower
HRQoL. To address objective (A), a systematic review (SR) of 14 eligible studies was
conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis
(PRISMA) guidelines. Results showed that the successful interventions provided a
combination of direct and indirect behavioral skills or, at the very least, indirect
behavioral skills such as stress reduction and coping strategies lasting at least two
months. To address objective (B), a sample of adolescents with T1D (n=5,799) from the
T1D Exchange Clinic Registry was analyzed. Descriptive statistics showed that those
with lower HRQoL whose SRH was “fair” or “poor” (n=600), 62% were female, 59% were aged 16-18 years, 66% had public or no insurance, and 93% had high HbA1c.
Logistic regression results showed that the most significant factor associated with lower
HRQoL (SRH) among adolescents with T1D is stress. Both the systematic review and
secondary data analysis identified stress as important factor in contributing to lowering
HRQoL among T1D adolescents. Health care providers and researchers should design
optimal DSME interventions that target stress as one of the most important factors
associated with lower HRQoL among adolescents with T1D.
