Attributions of Adolescents with Type 1 Diabetes Related to Performing Diabetes Care around Friends and Peers: The Moderating Role of Friend Suppor

To examine the relationships among negative attributions of friend and peer reactions to diabetes management in social situations, anticipated adherence difficulties, friend support, diabetes stress, and metabolic control.

Results Structural equation modeling demonstrated an excellent fit of two models depicting the mediating role of anticipated adherence difficulties and diabetes stress on the relationship between negative attributions of friend (first model) and peer (second model) reactions and metabolic control. Friend support was found to moderate the path between diabetes stress and metabolic control in an unexpected manner. That is, as friend support increased, so did the relationship between stress and metabolic control.

Conclusions Adolescents who make negative attributions about reactions of friends and/or non friend peers are likely to find adherence difficult in social situations and have increased stress, with the latter associated with metabolic control. Results are discussed in terms of a social information processing model of adjustment.

Management of Type I insulin-dependent diabetes involves adherence to a series of complex daily behaviors such as monitoring blood glucose levels, injecting insulin, carefully maintaining diet plans, and exercising. The maintenance of these adherence behaviors is seen as the best way to maximize a long-term positive prognosis and decrease the likelihood of short-term complications (e.g., hypoglycemia, hyperglycemia, ketoacidosis) and long-term negative consequences (e.g., renal failure, retinopathy).

Even though adolescents possess greater diabetes knowledge than children, they tend to have more problems with adherence. Social situations, especially those involving friends, may negatively impact the adherence behavior of adolescents and adolescents report that adherence difficulties are more frequent in social and peer contexts (Berlin et al., 2006). Some adolescents may feel unable to maintain their regimen within these contexts because they anticipate peer pressure or are apprehensive about being singled out by others . These results suggest that cognitive appraisals of social situations may be related to adherence behavior.

Decisions to avoid adherence behaviors around friends are problematic because adolescents are missing opportunities for support. Despite adolescents’ apprehensions to the contrary, friends of teenagers with Type 1 diabetes have been found to provide both emotional and companionship support and support for some aspects of the treatment regimen.

One possible reason for this lack of relationship is the role of attributions and cognitive appraisals, which when positive may serve as a protective factor and when negative may impact the adjustment of adolescents with chronic illness (Wallander & Varni, 1992).

The role of friend support was only found to moderate the path between diabetes-stress and metabolic control. Thus, it appears that friend support may not have a large impact on the nature of the relationship between attributions of others’ reactions and anticipated adherence difficulties, or the relationship between adherence difficulties around others and diabetes stress. In a seemingly paradoxical fashion, as friend support increased, so did the relationship between stress and metabolic control. A few interpretations of this finding are possible. First, for adolescents experiencing greater stress or poorer metabolic control, their friends become more supportive, but these friends may not be effective in helping them manage their diabetes-related difficulties. Alternatively, adolescents with higher diabetes stress may not make good use of coping support from friends, or they may actually find increased friend support as aversive. Finally, the support efforts by friends may actually be maladaptive, encouraging the adolescents to make poor behavioral choices. These alternative explanations regarding the impact of friends should be examined in future research.


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