Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Background: Type 1 diabetes (T1DM) is a chronic illness that requires intensive treatment to improve glycemic control and limit the risk of diabetes-related complications. The management of T1DM is challenging for adolescents as the diabetes self-care activities invade all aspects of their life. Older adolescents frequently have poor glycemic control which places them at increased risk for diabetes-related complications.

Study Aim:The goal of this study was to explore diabetes self-care practices among older adolescents, 15 through 18 years old, with T1DM. Specifically, this study sought to determine if there was a difference in diabetes self-care practices between adolescents who exhibited good (HbA1c < 9%) versus poor (HbA1c > 9%) glycemic control.

Study Design:This study used an exploratory, focus group design to gain a better understanding of diabetes self-care among older adolescents and how they integrate diabetes self-care activities into their lives. Six focus groups were conducted and adolescents (n = 21) participated in either a good (HbA1c < 9%, n = 13) or poor (HbA1c > 9%, n = 8) control focus group according to their reported HbA1c.

Results: Inductive analysis revealed 17 themes for adolescents in good control and 16 themes for those with poor glycemic control which were categorized as life with

T1DM; diabetes self-care; interactions with parents, teachers/coaches, or others; or interactions with the healthcare team.

Nursing Implications:Understanding the older adolescent's views about having diabetes and incorporation or lack thereof of diabetes self-care provides valuable information for nurses to develop a trusting relationship with them which may assist with improvement of glycemic control.

Conclusions: Teens with good control believed they were stronger than the disease and that diabetes self-care is something they have to do to feel good physically. In contrast, teens with poor control often forgot to perform diabetes self-care activities and had to adjust their lifestyle to fit their chronic hyperglycemia. Teens in good control have accepted the disease and diabetes self-care as part of their identity where teens in poor control described having diabetes and its self-care activities as a burden and something that made them different from their peers.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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