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Is an autoimmune disease where the immune system attacks the pancreas and stops insulin production.
This means individuals with the condition need to manage blood sugar levels by administering insulin either through regular injections or an insulin pump.
Can cause short term and long term complications due to uncontrolled management.
The illness affects individuals on a daily basis by constantly having to monitor and keep blood sugars to a healthy level. On a day to day basis low blood sugars (hypoglycemia) is an example, it causes:

Fatigue

Feeling disorientated

Sweating

Blurred vision

Or high blood sugars which can effect concentration and make individuals feel fatigued.

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Type 1 diabetes affects the body such that it can no longer produce insulin

Type 1 diabetes is an autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels.

Type 1 diabetes may sometimes be referred to as juvenile diabetes, however, this term is generally regarded as outdated as, whilst it is commonly diagnosed in children, the condition can develop at any age.

Insulin dependent diabetes is another term that may sometimes be used to describe type 1 diabetes.

Because type 1 diabetes causes the loss of insulin production, it therefore requires regular insulin administration either by injection or by insulin pump.

Type 1 diabetes symptoms

Type 1 diabetes symptoms should be acted upon immediately, as without treatment this type of diabetes can be deadly.

Symptoms include:

Type 1 diabetes tends to develop more slowly in adults than it does in children and in some cases type 1 diabetes in adults may be misdiagnosed as type 2 diabetes.

Type 1 diabetes in adults over 35 years old will sometimes be referred to as Latent Autoimmune Diabetes of Adulthood (LADA).

Type 1 causes

Type 1 diabetes is caused by a fault in the body's immune response in which the immune system mistakenly targets and kills beta cells, the cells in the pancreas responsible for producing insulin.

As more insulin producing cells in the pancreas are killed off, the body can no longer control its blood glucose levels and the symptoms of diabetes begin to appear.

What causes the initial fault in the immune system is yet to be discovered, however, research suggests that the condition results from a combination of genetic predisposition with an environmental trigger.

What triggers the immune system to behave this way is yet to be conclusively identified. To date, the strongest evidence points towards avirus as being the most likely trigger.

Diagnosis

If you show signs of having diabetes, your doctor may use blood or urine tests to diagnose diabetes. Your doctor should consider which type of diabetes you have as this can affect how your diabetes is treated. If the type of diabetes is unclear, your doctor may decide to carry out one or more of the following tests:

Because type 1 diabetes can develop quickly within children and young adults, a diagnosis of type 1 diabetes should be followed by same day referral to a multidisciplinary paediatric diabetes care team.

Type 1 diabetes is an autoimmune disease that causes the body to kill off its own insulin producing cells. Unlike type 2 diabetes, there exists no link between body size and type 1 diabetes.

Type 1 diabetes usually starts in childhood but can start in adulthood too. Type 1 diabetes can come quickly and symptoms can get stronger by the day. The earlier it's diagnosed the better. The symptoms of type 1 diabetes are a reaction to the high amount of sugar in the blood.

The body will try to flush out excess sugar through urine which means you will be going to the wee a lot; especially at night, drinking much more than normal, you may also notice itching down below. Less insulin means the sugar in your blood can't fuel your body cells so you'll feel tired and lethargic, and may experience rapid weight loss.

If diabetes is left to develop, you may notice you get either blurred vision or start vomiting. If you notice these symptoms act quickly and arrange to see a doctor immediately.

If you have some of the symptoms, arrange to see a doctor who will take a finger prick blood glucose test or possibly a urine test. The doctor may be able to diagnose you there and then.

Type 1 diabetes is treated by taking insulin You will start by taking injections and can either continue taking injections or may move onto being treated by an insulin pump.

You will need to regularly test your blood, with finger prick tests. Injections and blood tests do get easier over time. You will also need to be aware of what you're eating, particularly how much carbohydrate you're having.

We don't know. Research hasn't been able to give a clear answer to this yet. What we do know is that genetics plays a part and there seems to be a link with vitamin D, although the link is not currently well understood.

A diagnosis of diabetes is not all doom and gloom. With good control you can lead a long and happy life. People with type 1 diabetes have been known to live into their nineties.

One such person is Bob Krause who lived with type 1 diabetes for over 85 years.

Download a FREE blood glucose chart for your phone, desktop or as a printout.

Treatment for type 1 diabetes

The impairment of the pancreas' ability to produce insulin in type 1 diabetes means that insulin treatment is necessary.

Most people will take insulin by injection with insulin pens. Insulin can also be delivered by wearing an insulin pump. Use of an insulin pump will be considered in people that express an interest in having one and that meet certain eligibility criteria.

It is important that you are given education on how to balance insulin doses with dietary intake and physical activity and how to use blood glucose testing to help you control your diabetes.

Staying physically active and exercising regularly and eating a healthy diet are also important towards maintaining good blood glucose control and minimising the risk of long term diabetes complications. Although diet and exercise have a role to play in type 1 diabetes management, they cannot reverse the disease or eliminate the need for insulin.

Type 1 diabetes and complications

Type 1 diabetes is a serious condition which can carry a significant risk of both short term and long term complications.

Short term complications

Short term complications can occur if blood glucose levels go too low or if insulin injections are missed. The short term complications that can occur are:

Hypoglycemia - too low blood sugar levels

Ketoacidosis - which can occur if insulin doses are missed or blood glucose levels become too high

Long term complications

Type 1 diabetes can lead to the development of the following long term diabetes complications:

Whilst the list of complications is a scary prospect, the chances of developing these can be significantly reduced by maintaining good control of your blood glucose levels and ensuring you attend all your diabetic complication screening appointments.

Prevention

In future, research may find a way to halt the development of type 1 diabetes but, to date, no intervention has successfully preventing type 1 diabetes in humans.

Type 1 diabetes research

Researchers from around the globe are looking for ways to improve type 1 diabetes treatment and to investigate possible cures. Important research areas include:

Type 1 diabetes facts

The risk of developing type 1 diabetes can be affected by your genetics; i.e. if your parents or siblings have type 1 diabetes.

In terms of inheritance of type 1 diabetes - there is a 2% risk if the mother has type 1 diabetes, 8% risk if the father has type 1 diabetes; and a 30% risk of the child developing type 1 diabetes if both parents are type 1

Within 20 years of diagnosis of type 1 diabetes, nearly all of those diagnosed have some degree of retinopathy

There is also a sub-type of type 1 diabetes known as brittle diabetes.

Famous people with type 1 diabetes include:

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Type 1 diabetes affects the body such that it can no longer produce insulin Type 1 diabetes is an autoimmune disease that causes the insulin producing beta cells in the pancreas to be destroyed, preventing the body from being able to produce enough insulin to adequately regulate blood glucose levels.

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There are approximately 400,000 people in the UK with type 1 diabetes, over 29,000 of them are children.
About 10% of diabetics are type 1.

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The incidence of type 1 diabetes is growing at an alarming rate. View the latest figures and links to national public information resources below.

Quick facts

Approximately 400,000 people are currently living with type 1 diabetes in the UK, with over 29,000 of them children

Incidence is increasing by about four per cent each year, particularly in children under five, with a five percent increase each year in this age group over the last 20 years

Type 1 diabetes affects 96 per cent of all children with diabetes in England and Wales

Around 85 per cent of people diagnosed with type 1 diabetes have no family history of the condition

Although it used to be referred to as 'juvenile diabetes', around half of newly diagnosed cases are in people over the age of 18

The UK has one of the highest rates of type 1 diabetes in the world, for reasons that are currently unknown

A person with type 1 diabetes will have around 65,000 injections and measure their blood glucose over 80,000 times in their lifetime

Public information resources

National Diabetes Audit - One of the largest annual clinical audits in the world. It measures the effectiveness of diabetes care against National Institute of Clinical Excellence clinical guidelines and quality standards.

Quality and Outcomes Framework - This is the annual programme that details GP practice achievement results and rewards practices for the achievement of quality care. The QOF awards practices achievement points for managing some of the most common chronic diseases, diabetes being one.

We promise to keep your details secure and we won't share your information with any other organisations. If you decide you'd rather not hear from us then you can unsubscribe at any time.

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The incidence of type 1 diabetes is growing at an alarming rate. View the latest figures and links to national public information resources below.

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Psychological guide to coping with diagnosis from Dr Jen Nash

5 stages of grief: Denial, anger, bargaining, depression and acceptance.

many people can fluctuate between these stages for many years, perhaps with small acceptances along the way.

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Diabetes diagnosis can bring about feelings of grief

The memory of the moment of the diabetes diagnosis is a profound one. Psychologists call it a 'flashbulb' memory, in which you can recall all the exact elements of the moment heard the news, with startling clarity.

Dealing with the diabetes diagnosis has been compared to the experience of grief.

This is the first psychological guide from Dr Jen Nash and is designed to help people to come to terms with their diabetes diagnosis.

What's in this guide?

There are 3 parts to this guide on coping with diabetes diagnosis:

Emotional impact of diagnosis

The diabetes diagnosis can cause a grieving for your lost health, in the same way as you may grieve for a lost loved one. It is a natural human tendency to live life rarely thinking about our health or mortality.

And why should we, until something life-changing happens, such as being diagnosed with a chronic health problem such as diabetes. Suddenly, you are hyper-aware that no life is without its limits.

Below is an outline of the stages of grief - do you recognise any of these descriptions in your feelings towards diabetes?

The 5 stages of grief

Below is an outline of the stages of grief - do you recognise any of the descriptions in your feelings towards diabetes?

You may not have experienced all of these emotions towards diabetes, or in this particular order.

Experiencing the emotions

However, I'm sure you can see the similarities between these thoughts about diagnosis, and thoughts you may have when faced when you lose someone close to you.

In fact many people fluctuate between these different stages for many years, getting stuck at denial, or between anger, bargaining and depression, perhaps with small acceptances along the way.

The experience and after effects of diagnosis can resonate for a long time, so whether you are recently diagnosed or have had diabetes for many years, you may still be experiencing its impact. You can help yourself manage the potential difficulties better if you can recognise at which stage of the 'grief' process above you are currently in.

This is one of series of Psychology articles by Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

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Coping With Diagnosis - Emotional Impact and 5 Stages of Grief

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The memory of the moment of the diabetes diagnosis is a profound one. Psychologists call it a 'flashbulb' memory, in which you can recall all the exact elements of the moment heard the news, with startling clarity. Dealing with the diabetes diagnosis has been compared to the experience of grief.

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Quality of life of adolescents with diabetes and parents' illness perception
Terrasson, Terade, Somat, Nivot-Adamiak, Guitteny, Kerdanet (2017)

The effects and treatment/management people must follow can lead to deteriorated in quality of life especially for adolescents

Patients illness perceptions have shown to effect quality of life but do others illness perceptions also have an effect?

Investigated links between quality of life and illness perceptions. Measured: adolescents self-perceptions, parents self-perceptions and adolescents evaluations of their parents preconceptions

QOL was predicted by: Gender, parents emotional representations and perceptions of consequences

Shows parents perceptions on QOL of adolescents with type 1 diabetes.

This new approach provides new insights into the impact of parents’ perceptions on the quality of life of adolescents with type 1 diabetes.

Psychological barriers to optimal insulin therapy
Wisting, Bang, Skrivarhaug, Dahl-Jørgensen, Rø (2016)

Aim was to investigate psychological barriers, this include illness perceptions, insulin beliefs and coping strategies, with a specific focus on gender differences and type of treatment (insulin pen or pump).

The Brief Illness Perception Questionnaire, the Beliefs about Medicines Questionnaire, and the Adolescent Coping Orientation for Problem Experiences were used.

Females had significantly more negative illness perceptions than males on all areas.

no difference on insulin necessity, females scored higher on insulin concern and females scored higher on coping strategies (being social and solving family problems).

Patients using insulin pen reported more negative perceptions of treatment control than patients using insulin pump.

Addressing psychological aspects may be a clinically important supplement to standard somatic T1D care.

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Health Behaviour in Children and Adolescents compared to Representative population
Kummer et al

Looked at health behaviours in children/adolescents with type one in comparison to the general population using questionnaires.

Children and adolescents with type were significantly more likely to have infrequent physical activity and high computer and television use.

Active smoking and prolonged use of computer were associated with higher HBA1c.

They did show a different profile of health behaviour.

good glycemic control depends not only insulin but on health relevant behaviours; physical activity, nutrition, smoking and psycho-social parameters, which have a significant impact of quality of control.

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"A person with type 1 diabetes will have around 65,000 injections and measure their blood glucose over 80,000 times in their lifetime" JDRF (2018)

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"And they pretty much told me over the course of a couple
of days how to inject, how to read labels, how to manage
the disease but not how to manage everything else. "

(Female, age 30, diagnosed at 29 years)

(Clarke et al., 2017)

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Diet and Healthy Eating (Health Behaviours)

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Diet and Healthy Eating (Health Behaviours)

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Carbohydrate counting: helps balance insulin intake with the food people eat. People can take courses teaching how to carb count (DAFNE).

Making sure to have a healthy balanced diet.

Low carbohydrates diets.

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Different foods impact your blood sugars differently

The dietary advice generally given to people with type 1 diabetes is not much different to the dietary advice for people without diabetes.

The main issues to consider are how sharply different foods are likely to impact on your blood glucose levels and how to balance the quantity of carbohydrate with the right amount of insulin.

Carbohydrate counting

Carbohydrate counting plays a key role in helping to balance insulin intake with the food you eat.

A number of carbohydrate counting courses are available including the DAFNE course (dose adjustment for normal eating) which is widely recommended by people who have been on it.

Another carbohydrate counting resource which is quickly growing in popularity is the Carbs and Cals book which shows, in pictorial form, how many carbohydrates are in a huge variety of different meals and portion sizes.

Healthy eating for type 1 diabetes

Eating healthily comes highly recommended and can play a part in helping to prevent the development of complications.

Eating a balanced diet, containing a variety of different vegetables, will help to provide many nutrients that the body needs.

Try to include foods containing unsaturated fats such as nuts, avocados and oily fish.

We recommend limiting the amount of processed foods you eat and try to include home prepared or freshly prepared food wherever possible.

Low carb diets and type 1 diabetes

Some people with type 1 diabetes may wish to adopt a reduced carbohydrate diet. Low carb diets can be helpful for people who are struggling to keep control on a carb centered diet or for those who are otherwise looking to tighten their control.

A healthy diet for type 1 diabetes is broadly similar to the guidelines for people without diabetes. The differences between a diet for type 1 diabetes and someone without diabetes are:

People with type 1 diabetes need to be more careful with intake of sweet foods

The amount of carbohydrate eaten should be balanced with an appropriate amount of insulin

The general guidelines for a healthy diet are:

Eat at least 5 portions of fruit and vegetables each day

Include fish and lean meats in preference to red meats

Include unsaturated fat in preference to saturated fat

Eat less sugar and salt

Key to controlling type 1 diabetes is matching carbohydrate intake with the correct amount of insulin. Blood glucose testing can help you to see how different foods affect your blood glucose levels and help you to balance your insulin doses. Testing your blood glucose before a meal and at intervals of 2 and 4 hours after eating is a great way to see how your blood sugar levels respond.

Some people with type 1 diabetes may wish to reduce their carbohydrate intake to help minimise swings in blood glucose levels. If you wish to carbohydrate intake discuss how to safely do this with your diabetes specialist who can help you to safely adjust your doses.

One of the benefits of reducing your intake of carbohydrate is in reducing the extent of post meal high blood sugar levels.

Lower carb diets will require a reduction in insulin and could result in hypoglycemia if doses are not changed correctly. It is recommended to speak to your doctor before going onto a significantly different diet.

Explore Type 1 Diabetes Diet

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Different foods impact your blood sugars differently The dietary advice generally given to people with type 1 diabetes is not much different to the dietary advice for people without diabetes. The main issues to consider are how sharply different foods are likely to impact on your blood glucose levels and how to balance the quantity of carbohydrate with the right amount of insulin.

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Statistics

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"Well  specifically  regarding  mental  health,  this  is  the  first
I’ve heard of research into mental health conditions within
type 1 diabetes. I guess it’s always the medical aspects that
I’ve seen. But I always feel like [ ] they’re looking for other
people to get the information from, not me personally."

(Female, age 20, diagnosed at 12 months)

"Even just admitting that someone has anxiety or you need help, can be seen as almost a weakness. And if you already have a chronic illness you don't want to admit that to yourself. "

(Female, age 18, diagnosed at 12 years)

Quotes from Clarke et al. (2017) qualitative analysis (young type 1 diabetic attitudes)

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Attitudes towards mental health research and interventions by young adults with type 1 diabetes

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Attitudes towards mental health research and interventions by young adults with type 1 diabetes

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Clarke et al. (2017)

Young people with type 1 have an increased risk of mental health problems. Treatment need is high, however there is a difficulty in recruiting young people into these psycho-social studies and interventions.

People were mainly unaware of their increased risk to common mental health and self-management issues.

An issue for research/interventions with young type 1 diabetics is difficulty recruiting people.

Higher number of participants in interventions can be helped through online interventions due to accessibility of use.

Big motivating factor to engaging with interventions was making a difference to other type 1 diabetics lives. They thought the opportunity to engage with other people with the same illness would be helpful.

Education evaluated to be a very important factor in interventions.

Health care providers have little to no discussion about psycho-social issues.

Try to not admit emotional difficulties for the fear of having more labels and guilt.

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Internet Psycho-Education Program (Grey et al  2013)

Determined the efficacy of two internet based psycho-educational programs designed to improve outcomes for young people transitioning to adolescence.

Primary outcomes were better blood sugar levels and quality of life (QOL). Secondary outcomes included; coping, self-efficacy, social competence, self-management and family conflict.

Youth who had completed both programs had lower blood sugars higher social acceptance, self efficacy and lower perceived stress.

Internet interventions resulted in improved outcomes but completion of both was better than one. This suggests that you need both educational and behavioural interventions.

Delivering these programs through the internet represents an efficient way to reach youth and improve outcomes.

Study of Coping anxiety and glycaemic control in type 1 (Sultan, Epel, Sachon, Vaillant, Heurtier 2006)

Diabetes requires a high degree of individual self management strategies. Anxiety and stress can impact glycemic control therefore management of emotions may be the key to good control.

Study examines how anxiety, coping style and their interaction can effect long term control for diabetics.

Found that coping predicted outcomes especially for those high in trait anxiety.

Lower levels of emotion-orientated coping predicted clinically significant increase in blood sugars (HBA1c's).

Task orientated coping predicted decreases in state anxiety. The use of task and emotion-orientated coping appears to be especially important for highly anxious patients, both for emotional regulation and glycemic control.

Concluded coping styles, anxiety and their interactions should be considered in designing follow up interventions with diabetic patients.

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Change and stability in depressive symptoms in young adults with type 1 diabetes

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Change and stability in depressive symptoms in young adults with type 1 diabetes

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Oris et al., 2016

Examined inter-individual differences in depressive symptom development in young adults with type 1.

Individuals with persistent depressive symptoms were at risk for bad development in terms of; illness perceptions, illness functioning and self-esteem.

People with diabetes twice as likely to have a lifetime depressive disorder as the general population and 20-25% of diabetics are affected by depressive symptoms. These symptoms have been linked to poor treatment adherence, increased health care costs and diabetes complications.

Also assessed how stability and change in depression moderated the development of self-esteem, illness perceptions (perceived consequences and control).

this study emphasises the need to be attentive for depressive symptoms in patients with diabetes, especially when symptoms persist over time. Given the consequences and health care costs.

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Psychologist Dr Jen Nash reveals the reasons why people with diabetes struggle with emotions and explains what research evidence from psychological studies tell us about how to cope with them.

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For anyone with diabetes, experiencing negative emotions such as anger, frustration, hopelessness, fear, guilt and shame is very common. According to NICE when a person is first diagnosed with diabetes, they will often go through similar psychological stages as that of bereavement: Disbelief Denial…

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Effect of stress management training on glycaemic control in patients with type 1

Attari, Sartippour, Amini, Haghighi (2006)

Looked at the effect of stress management training on glycemic control.

Subjects attended 3 months stress management training classes during which their prescribed insulin remained the same. HBA1 from all participants were measured before and after intervention.

Participants who had intervention training showed significantly improved ways of coping. Blood sugars also improved.

Results show a clinically significant beneficial effect of stress management training on glycaemic control.

Facilitating narrative medical discussions of type one diabetes with computer visualisations and photography (Smith, Frost, Albayrak & Sudhakar, 2006)

Patients and physicians have different goals and discourse styles during consultations, attempts to bridge these differences by providing patients with ways to collect, visualise, and describe their behaviour.

Intervention where type one diabetics photograph health related behaviours. The images and blood glucose records are displayed in computer visualisations and are used during patient-physician interviews.

The visualisations help individuals articulate concerns about stress, peer relations, and unhealthy routines.

Interventions that include biomedical and bio-psychosocial data during patient-practitioner consultations may be beneficial with patients. Helps them to; reflect on correlations between behaviours and health, and physicians can understand patients issue and diabetes management better.

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Quality of Life Measure: Diabetes Quality of Life for youth scale (DQOLY)

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Quality of Life Measure: Diabetes Quality of Life for youth scale (DQOLY)

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Skinner, McGee & Skovlund (2006)

Tested the construct validity of the DQOLY scale in a large representative sample of young people with type one diabetes.

Tested on 2,077 young adults across 18 countries across Europe from paediatric diabetic centres.

Measures: Impact of diabetes (23 items), worries about diabetes (11 items), satisfaction with treatment (10 items), satisfaction with life (7 items) and one single item on health perception.

Using exploratory factor analysis and confirmatory structural modally for the structure of the DQOLY was broadly supported.

The questionnaire is 52 items long, however this is very long and limits clinical utility. The researchers examined the construct validity and the possibility of making a shortened scale.

Analysis identified a possible shorter from which had: good construct validity, was equally valid for both sexes and seemed to be internally consistent across countries.

Further studies are needed to address the criterion and predictive value of the shortened measure. Interestingly the the physical consequences sub-scale indicated a noticeable stronger association than the other 5 sub-scales.

The shortened scale will enhance acceptability of assessing quality of life in adolescents with diabetes, making it more feasible to introduce as part of routine care.

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Association of Depression and Diabetes Complications: A Meta-Analysis
Groot et al (2001)

Examined the strength and consistency of the relationship between depression and diabetes complications in type 1 and type 2 patients.

Meta-analysis of articles examining depression and complications.

The likelihood of comorbid depression is approximately 30% of patients with type one and two diabetes.

Predicted that improvements in depressive symptoms would improve glycemic control.

Previous research such as a controlled trial of cognitive behavioural therapy (CBT) for depressive symptoms demonstrated the improvements in patients glycemic control.

Results indicated depression was consistently associated with increased severity of diabetic complications.

This was found in both types and may suggest common pathways.

Depression was associated with a variety of complications.

The study demonstrates a significant and consistent association of complications and depressive symptoms. Longitudinal studies are needed to identify pathways that mediate this association.

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Integrates diabetics from around the world and makes socialising easy. You can take polls, ask questions, answer questions

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Symptoms reported by diabetics on the right.

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Symptoms reported by diabetics on the right.

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Internet Intervention to help young type 1's with self-management

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Internet Intervention to help young type 1's with self-management

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(Mulvaney, Rothman, Wallston, Lybarger, & Dietrich, 2010)

Based on social-cognitive and self determination theories.

Participants either had usual care or usual care with the internet-based problem solving management support.

11 weeks, included multimedia stories showing psychosocial barriers and problem solving approaches and coping skills.

This brief trial suggests that self-management support delivered through a secure website may improve self-management and blood glucose control for young adults with type 1 diabetes.

Rated positively by participants involved.

Use of the internet is effective as it improves accessibility.

Small sample used.

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Design and development of a stepped-care behavioural intervention to support parents of young children newly diagnosed  

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Design and development of a stepped-care behavioural intervention to support parents of young children newly diagnosed  

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Hilliard, Tully, Monaghan, Wang & Streisand (2017)

parents are at risk for elevated psychological distress, especially immediately after diagnosis.

few interventions available to support parents and children during this vulnerable period.

aim of study: evaluate stepped care behavioural intentions for parents over the first year. Outcomes were to help children's glycemic control, parents and children's psycho-social functioning

significant challenges to optimal T1D management in newly diagnosed children include;  developmental challenges of unpredictable diet, behaviour, and physical activity patterns, increased insulin sensitivity, and social and behavioural development

Parents experience high levels of stress surrounding their child's T1D diagnosis, and providing support tailored to each individual family's needs may offer psychological and medical benefits

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Self Management and Self Management Interventions 

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Self Management and Self Management Interventions 

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Newman, Steed & Mulligan (2004)

Management of most chronic illnesses characterised by extensive responsibility patients need to take with their illness. Whether medication, lifestyle changes, preventative action patients and carers make day to day decisions about what action needs to be taken. This involvement is referred to as self-management.

In order to have successful self-management individuals need to be able to monitor their condition and the effect to cognitive, behavioural and emotional responses have to maintain a satisfactory quality of life. Self-management is more than just treatment plans but includes social and psychological aspects to the management of people’s illnesses.

Optimal self-management is difficult to achieve, this is displayed in poor adherence to treatment guidelines and poor psychological wellbeing.

Aims of self-management interventions (SMI) are: increasing individual’s involvement and control in their treatment and chronic illness.

Most studies using self-management interventions led to better outcomes than standard care or basic information (71% for diabetes).

Small samples unlikely to have reliable results, been recognised in diabetes studies as before 2002 the mean of participants was smaller than after 2002.

Using group interventions positives: reduces costs and potential group learning, however, individual interventions are good because can tailor them to individual’s needs.

Study on diabetes and SMI’s comparing group and individual interventions found that the group one had greater improvements in blood glucose but only blood glucose.

Lay leaders vs using health care professionals: lay leaders (cheaper, act as role models), health care professionals (address factual issues related to illness) not much evidence on which is more effective or whether certain groups are better at delivering SMIs.

Social learning theory used to help problem solving and goal setting to increase individual’s self-efficacy and increase health-related behaviours (blood glucose monitoring).

In diabetes SMIs more intensive interventions led to greater health behaviours, group interventions are better for blood glucose control and motivational interviewing led to better HbA1c and more frequent blood glucose testing.

Assessment of psychological well-being as an outcome, difficult because even though mental illness rates are higher than the general population, many people on the self-management programmes might not have depressed symptoms or increased anxiety. Expecting this to improve is unrealistic?

Using cognitive behavioural components in interventions helped psychological well-being.

Link between quality of life (QoL) and interventions is not yet understood, further research is needed.

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It is an individual's ability to manage their symptoms, treatment, physical and psycho-social consequences and life changes, it has been said to be essential to living with a chronic health condition (Barlow,  Wright, Sheasby, Turner & Hainsworth, 2002)
It is characterised by the involvement of their care and involves both psychological and social concepts (Newman et al., 2004)

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Wiebe, Berg, Mello, Kelly (2018)

Better management occurs when individuals actively regulate involvement with others and seek help.

Young adults are at risk for poorer management of type 1 diabetes: changing relationships, social context of diabetes needs to be regulated.

18-30 years is a high risk time for management due to the uncertainty in life: moving out; university/working life; transfer from paediatric to adult care.

Less than a third of emerging adults meet recommendations for self-care and blood sugar control.

Self-management behavioural example for young people: when out for dinner must test blood sugars and adjust insulin. This involves emotional regulation by reducing the distress of managing diabetes, cognition by remembering to test  and calculate carbohydrates then inject appropriately. Social aspects: must ask for help to stop potential interference's with testing/injecting.

managing T1D is a complex regulation task that involves emotions, cognition's and behaviours that support diabetes management.

Interventions may be useful for young people with self-regulation issues and helping daily life.

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Steed et al. (2005)

Self-management is the cornerstone of care for diabetes.

Health behaviours diabetes are very big although this is known, many individuals have difficulty carrying out the necessary behaviours.

Creating interventions targeting the maintenance of these behaviours is important and needs to be developed.

Many interventions out there are limited by poor methodologies and has lead to a lack of systematic development of interventions.

Steed developed a self managament programme based on Bandura's social cognitive theory and self-efficacy.

Used problem solving and practical skills skills through 5 group sessions, individuals were given the opportunity to discuss difficulties with others as well as being taught healthy behavioural techniques.

Intervention improved self-management and quality of life of participants following the programme.