Introduction: T1D poses unique challenges to adherence-related behavior due to complex treatment regimens. This study aimed to determine prevalence rates of adherence in adolescents on multiple daily injections (MDI) or subcutaneous insulin infusion (CSII). Additional aims included determination of whether adherence correlated to HbA1c and whether psychological factors predicted adherence.

Methods: Self-monitoring of blood glucose (SMBG) and insulin delivery data were downloaded for the previous 30 days. Distress was measured using the Problem Areas in Diabetes-Teen Version, the Blood Glucose Monitoring Communication Questionnaire, and the Barriers to Diabetes Adherence survey. The Hypoglycemia Fear Survey and Behavior Rating of Executive Function were administered. Bivariate correlations and hierarchical regressions were used to determine how adherence related to HbA1c and the predictive value of psychological factors. Continuous glucose monitor (CGM) use was considered as a covariate.

Results: Adolescents (N=81; 41 on MDI and 40 on CSII; 32 on CGM) aged 11 to 17 years completed the study. The mean HbA1c was 8.74% (SD=1.74%). Daily, <7% of participants engaged in SMBG ≥4 times; <7% engaged in carbohydrate entry ≥3 times, and <20% engaged in bolus delivery ≥3 times. Hyperglycemia readings were followed by a correction bolus in 58% of cases. HbA1c was negatively correlated with several adherence domains: frequency of SMBG (r=-0.465, p<.01), carbohydrate entry (r=-0.511, p<.01), and bolus insulin delivery (r=-0.522, p<.01). Distress and fear of hypoglycemia predicted adherence to correction bolusing for hyperglycemia (R2=.237, p<.05) in a model with child age, gender, and executive functioning.

Conclusions: Findings suggest adolescents do not adequately adhere to treatment for T1D. The use of diabetes treatment technology is helpful to measure specific domains of adherence and clarify relationships with psychological factors.


S.C. Westen: None. J. Warnick: None. M. Entessari: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D.M. Janicke: None.

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 information is available at