Assessing treatment barriers in young adults with type 1 diabetes Blake M. Lancaster a, *, Beth Pfeffer b , Maxine McElligott b , Agnes T. Ferguson b , Marilyn Miller b , Dustin Wallace c , James T. Lane d a University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE, USA b The Nebraska Medical Center, Diabetes Center, Omaha, NE, USA c Mayo Clinic, Division of Endocrinology, Rochester, MN, USA d University of Nebraska Medical Center, Internal Medicine, Omaha, NE, USA 1. Introduction Glycemic control and adherence behaviors remain low for patients with type 1 diabetes (DM1) [1]. These low levels of glucose control and behavioral adherence produce significant physical and psychological complications for individuals with DM1 [2]. Complications such as blindness, lower limb amputation, renal failure, heart attack and stroke create obvious health impact for the individual, as well as a significant financial impact upon the health system as a whole [3]. While research suggests that adherence and glycemic control is poor in the adult population, the difficulties maintaining glycemic control and adherence behaviors during the transition to adolescents and young adulthood are not as well understood [4]. Evidence does exist, however, demon- strating that HbA1c levels are lower in the adult population than in the young adult population with DM1 [4–6]. Research has demonstrated poor adherence rates and glycemic control within the adult population and the prognosis is worse for the young adult population [7]. diabetes research and clinical practice 90 (2010) 243–249 article info Article history: Received 26 March 2010 Received in revised form 14 June 2010 Accepted 12 July 2010 Keywords: Young adult Type 1 diabetes Carbohydrate Education abstract Aims: The current study was designed to identify barriers that prevent young adults with DM1 from achieving glycemic control. Methods: Eighty-three young adult patients with DM1 [age 22.2 Æ 2.8 years (mean Æ SD), duration diabetes 11.3 Æ 5.6 years, HbA1c 8.8 Æ 2.1%] completed a battery of surveys asses- sing potential barriers to achieving glycemic control. Results of questionnaires were corre- lated with the patient’s most recent HbA1c, and a multiple regression analysis was conducted to determine what barriers were significantly associated with HbA1c levels. Results: Questionnaires that significantly correlated with HbA1c levels included the Conflict Subscale of the Diabetes Responsibility and Conflict Scale (r = .55, p < .01), the Modified Barriers to Adherence Questionnaire (r = .42, p < .01), and the Hospital Anxiety and Depres- sion Scale (r = .31, p < .05). An item analysis of the Modified Barriers to Adherence Scale suggested that patient confidence with carbohydrate counting was most statistically asso- ciated with HbA1c [F(3, 80) = 12.95, p < .01, R 2 = .35]. Conclusions: Results suggest that despite attempts to educate patients; barriers such as family conflict, psychological issues, and carbohydrate counting remain obstacles impeding glycemic control in young adults with DM1. # 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: University of Nebraska Medical Center, Munroe-Meyer Institute, 985450 Nebraska Medical Center, Omaha, NE 68198-5450, USA. Tel.: +1 402 559 6408; fax: +1 402 559 6864. E-mail address: blancaster@unmc.edu (B.M. Lancaster). Contents lists available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres 0168-8227/$ – see front matter # 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2010.07.003