Type 1 Diabetes Self-Management From Emerging Adulthood Through Older Adulthood Diabetes Care 2018;41:1608–1614 | https://doi.org/10.2337/dc17-2597 OBJECTIVE The purpose of this study of adults with type 1 diabetes was to analyze patterns of diabetes self-management behaviors and predictors of glycemic control across the adult life span. RESEARCH DESIGN AND METHODS This study was a secondary cross-sectional analysis of data of 7,153 adults enrolled in the T1D Exchange Clinic Registry who were divided into four developmental stages (emerging, young, middle-aged, and older adults). Data were collected by questionnaire and medical record review at enrollment. Statistical analyses compared sociodemographic, clinical, and diabetes-related factors across groups. Logistic regressions were conducted for each group to identify factors associated with hemoglobin A 1c ‡7%. RESULTS The sample was divided according to adult developmental stage: emerging adults, age 18 to <25 years (n = 2,478 [35%]); young adults, age 25 to <45 years (n = 2,274 [32%]); middle-aged adults, age 45 to <65 years (n = 1,868 [26%]); and older adults, age ‡65 years (n = 533 [7%]). Emerging adults had the highest mean hemoglobin A 1c level (8.4 6 1.7% [68 mmol/mol]), whereas older adults had the lowest level (7.3 6 0.97% [56 mmol/mol]; P < 0.0001). Emerging adults were less likely to use an insulin pump (56%) or a continuous glucose monitor (7%) but were more likely to miss at least one insulin dose per day (3%) and to have had an episode of diabetic ketoacidosis in the past year (7%) (all P < 0.0001). Different factors were associated with hemoglobin A 1c ‡7% in each age-group, but two factors were noted across several groups: the frequency of blood glucose checks and missed insulin doses. CONCLUSIONS When discussing diabetes self-management, providers may consider a patient’s developmental stage, with its competing demands (such as work and family), psychosocial adjustments, and the potential burden of comorbidities. Type 1 diabetes is a chronic illness that needs to be managed over a lifetime. Diabetes self-management is necessary to prevent common diabetes-related complications and includes eating a healthy diet, engaging in exercise, taking appropriate amounts of insulin, and self-monitoring blood glucose (1). Adults with type 1 diabetes are at higher risk for cardiovascular disease (CVD), but that risk can be significantly reduced through control of traditional CVD risk factors (e.g., blood pressure, lipids, smoking) (2). 1 New York University Rory Meyers College of Nursing, New York, NY 2 Yale School of Nursing, Orange, CT Corresponding author: Margaret M. McCarthy, mmm529@nyu.edu. Received 12 December 2017 and accepted 30 April 2018. © 2018 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More infor- mation is available at http://www.diabetesjournals .org/content/license. Margaret M. McCarthy 1 and Margaret Grey 2 1608 Diabetes Care Volume 41, August 2018 CLIN CARE/EDUCATION/NUTRITION/PSYCHOSOCIAL Downloaded from http://diabetesjournals.org/care/article-pdf/41/8/1608/527433/dc172597.pdf by guest on 18 February 2023