OBJECTIVE—To conduct a meta-analysis of the metabolic and psychosocial impact of continuous subcutaneous insulin infusion (CSII) therapy on adults, adolescents, and children. RESEARCH DESIGN AND METHODS—Studies were identified and data regarding study design, year of publication, sample size, patient’s age, diabetes duration, and duration of CSII therapy were collected. Means and SDs for glycohemoglobin, blood glucose, insulin dosages, and body weight for CSII and comparison conditions were subjected to meta-analytic procedures. Data regarding pump complications and psychosocial functioning were reviewed descriptively. RESULTS—A total of 52 studies, consisting of 1,547 patients, were included in the meta-analysis. Results indicate that CSII therapy is associated with significant improvements in glycemic control (decreased glycohemoglobin and mean blood glucose). A descriptive review of potential complications of CSII use (e.g., hypoglycemia, diabetic ketoacidosis [DKA], pump malfunction, and site infections) suggests a decreased frequency of hypoglycemic episodes but an increased frequency of DKA in studies published before 1993. CONCLUSIONS—CSII therapy is associated with improved glycemic control compared with traditional insulin therapies (conventional therapy and multiple daily injections) and does not appear to be associated with significant adverse outcomes. Additional studies are needed to further examine the relative risks of CSII therapy, including the potential psychosocial impact of this technologically advanced therapy.

Diabetes research and health care have traditionally been divided into two distinct areas for receiving medical care: pediatric and adult. We propose a fresh approach to providing care in which we consider the period of development after high school as a period of “emerging adulthood” for youth with diabetes. We argue that the traditional conceptualization of only two distinct groups of patients misses the unique personal needs of individuals immediately post–high school. We frame this discussion about the needs of these post–high school patients (∼18–30 years of age) within the context of a contemporary theory of post-adolescent development. With this developmental context in hand, we then review psychosocial research on youth with type 1 diabetes. Next we discuss current clinical perspectives and knowledge about the natural course of diabetes during these years. Armed with an understanding of development, psychosocial functioning, and overall health, we then consider the literature regarding transition programs for youth with chronic diseases—both diabetes and other illnesses. We conclude by presenting specific strategies and recommendations to help both pediatric and adult providers care for the transition needs of this vulnerable population of individuals with diabetes. Over the past century, traditional developmental psychology defined the time immediately after adolescence as the “young adult period” (3,4). In contrast, a leading contemporary developmental theorist (1,2) has argued that young adulthood does not begin until youth are in their late twenties or thirties and that the developmental stage between ∼l8 and 25 years defines a period called “emerging adulthood.” Recent cultural trends in America for young people in their twenties lead to delays in assuming adult roles with respect to marriage, parenting, and work. Arnett (2) suggests that today's young people “explore the possibilities available to them in love and work, and move gradually toward making enduring …

OBJECTIVE: To document the existence and prevalence of adolescent-generated diabetes management techniques. RESEARCH DESIGN AND METHODS: One hundred forty-four adolescents completed the confidential questionnaire developed for this study. Glycohemo-globin was also obtained for each individual. RESULTS: Within the 10 days before their clinic visit, many adolescents admitted to engaging in various mismanagement behaviors, with 25% admitting to missing shots. Parents tend to underestimate adolescent mismanagement. Missing shots was significantly related to poor control (P < 0.01). Older adolescents engaged in more mismanagement than their younger cohorts (P < 0.001). The questionnaire factored into two subscales: blatant mismanagement and faking. CONCLUSIONS: This study shows the importance of recognizing the prevalence of mismanagement among adolescents.

Weissberg‐Benchell J, Antisdel‐Lomaglio J. Diabetes‐specific emotional distress among adolescents: feasibility, reliability, and validity of the problem areas in diabetes‐teen version.

This study adds to the literature on the psychometric properties of the Problem Areas in Diabetes-Teen (PAID-T) and Parent (P-PAID-T) Versions. It also aims to shorten the measures of diabetes-specific distress, determine construct validity, and establish cutoff scores. Data are from two independent studies (N = 1,265). Adolescent–caregiver dyads completed measures of emotional distress, diabetes strengths, hemoglobin A1c, blood glucose checks, and average blood glucose. Exploratory and confirmatory factor analyses assessed factor structures for each measure. Correlational analyses provided support for concurrent validity. Receiver-operating characteristic curves identified cutoff scores based on clinically meaningful groups identified with latent profile analysis. Analyses supported a 14-item PAID-T and a 15-item P-PAID-T, with preliminary cutoff scores ≥44 and ≥54, respectively. Measures were associated with emotional and health outcomes as hypothesized. The PAID-T and P-PAID-T are valid, reliable, and useful measures of diabetes-specific distress for teenagers with type 1 diabetes and parents of teenagers.