Aim: The construct of illness identity may relate to one’s ability to accept and adjust to the daily rigors of T1D care. As identity formation is a major developmental process in all young persons, understanding the degree to which youth with T1D incorporate diabetes into their identities is particularly important. Thus, we developed ADAPT, a survey to assess incorporation of T1D into youth self-identity.
Methods: The ADAPT survey (18 items, 5 point Likert scale [strongly disagree to strongly agree]) was developed by a multidisciplinary team and refined through cognitive interviewing. Youth ages 8-25 years at 2 U.S. sites completed ADAPT to determine psychometric properties. Total scores range from 0-100 (higher score=greater T1D incorporation).
Results: ADAPT was completed by 100 youth with T1D (age [M±SD] 17.3±4.3 years, T1D duration 9.3±5.1 years, 40% male, 87% white, 76% pump users, 74% CGM users, A1c 8.4±1.1%). Of the original 25 items, 7 were removed due to ceiling effect or low item-to-total correlations. ADAPT demonstrated good internal consistency (Cronbach’s α=0.89). Mean score was 65±17 (range 24-100). Construct validity was demonstrated through significant associations with validated measures: greater T1D incorporation was associated with less hypoglycemia worry (r=-0.4), less diabetes distress (r=-0.7), and higher quality of life (r=0.4) (all p<.0001). Greater incorporation was also associated with lower A1c (r=-0.2, p=.03), male sex (p=.007), and insulin pump use (p=.02).
Conclusion: ADAPT demonstrated strong internal consistency and construct validity in technologically engaged youth with T1D. ADAPT may be useful in clinical and research settings, especially in the current era of advanced diabetes technologies, as degree of incorporation may indicate level of support needed for self-care success in order to attain optimal glycemic and psychosocial outcomes for young persons with T1D.
P.V. Commissariat: None. L.K. Volkening: None. L. Roethke: None. Z. Guo: None. J.L. Finnegan: None. E. Dassau: Consultant; Self; Eli Lilly and Company, Insulet Corporation. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Ltd., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; Roche Diabetes Care. Other Relationship; Self; ModAGC. S.A. Weinzimer: Consultant; Self; Eli Lilly and Company, Sanofi. Consultant; Spouse/Partner; Tandem Diabetes Care. Consultant; Self; Zealand Pharma A/S. Speaker's Bureau; Self; Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. Stock/Shareholder; Self; InsuLine Medical Ltd. L.M. Laffel: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Janssen Pharmaceuticals, Inc., UpToDate.
National Institutes of Health (DP3DK113511, DP3DK104057, T32DK007260, P30DK036836, K12DK094721)