Posted Feb 26 , 2018 01:31 AM

The Role of Peers for Diabetes Management in Adolescents and Emerging Adults with Type 1 Diabetes: A Longitudinal Study

Raymaekers K, et al. Diabetes Care 2017 Online ahead of print November 14th

What were the findings (excerpted from the Abstract)?

The increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged. However, longitudinal research linking the peer context to diabetes management and outcomes is scarce. The present longitudinal study in a large sample of youths with type 1 diabetes related both positive and negative peer variables to diabetes outcomes over a time interval of 1 year. The study sample consisted of 467 adolescents (14–17 years of age) and emerging adults (18–25 years of age) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-related distress, and treatment adherence. A1C values were obtained from the treating physicians of patients. Cross-lagged analysis from a structural equation modeling approach was performed to assess the directionality of effects. Peer support negatively predicted diabetes-related distress over time. Extreme peer orientation positively predicted treatment distress over time. Parental responsiveness negatively predicted food distress over time. Treatment adherence negatively predicted extreme peer orientation, treatment distress, and HbA1c values over time. For emerging adults specifically, there was a reciprocal relationship between HbA1c values and extreme peer orientation, because they positively predicted each other.

Why is this important?

This study highlights the importance of peers in predicting the functioning of youths with type 1 diabetes. Extreme peer orientation (the degree to which fitting in with peers is valued more than performing important age-specific tasks [i.e. performing academically]) was associated with treatment distress and worse glycemic control over time. There are other differences between the two cohorts which were not discussed, namely that 14-17 year olds tend to be living at home with parents present while 18-25 year olds (at least some) tend to leave home, go to college, etc. The study did not elaborate on the differences in diabetes control as represented by A1C for these differences. Other studies (Miller KM, et al. Diabetes Care 2015 Jun; 38(6): 971-978) have shown that this latter group has even poorer control than the adolescent cohort. In the US, a new organization, the College Diabetes Network, ( has begun to address the needs of the emerging adults group with a variety of programs and resources as well as peer relationship groups at an expanding number of institutions across the US. Future research needs to expand on the impact of peer relationships to adolescents and emerging adults and their diabetes control as well as overall well-being. Do you have resources in your practice to address adolescents and young adults? Were you aware of the impact of peer relationships in diabetes control in this cohort of people with type 1 diabetes? Will you change your practice regarding these groups based on this article?

Read the abstract: