Promoting Adherence to Medical Treatment in Chronic Childhood Illness: Concepts, Methods, and Interventions

By Dennis Drotar | Go to book overview

CHAPTER EIGHT Critical Issues in the Assessment
of Regimen Adherence
in Children With Diabetes

Alan M. Delamater University of Miami School of Medicine

Research indicates that poor glycemic or blood glucose control in persons with diabetes is eventually associated with serious health complications, including kidney disease, retinopathy, and neuropathy ( Clark & Lee, 1995). Attainment and maintenance of good glycemic control has therefore been considered a significant factor in diabetes management and prevention of complications ( Diabetes Control and Complications Trial Research Group, 1993), with improved glycemic control shown to reduce the risk of health complications even among adolescents (Diabetes Control and Complications Trial Research Group, 1994). Therefore, although the goal of diabetes management is to achieve normal glycemic control, the process by which good glycemic control is achieved is through adherence to regimen prescriptions. Thus, it is important for health care professionals working with children and adolescents with diabetes to accurately determine whether they are adhering well to the prescribed medical regimen.

The issues involved in adherence with diabetic regimens can be considered as a model for other chronic illnesses affecting children. The regimen is complicated and essential for sustaining life and, in the absence of a cure, is chronic. The diabetic regimen impacts on virtually all areas of everyday life, including dietary intake and physical activity. Additionally, it requires the administration of specific types and amounts of insulin at certain times throughout the day (prior to eating), testing of blood for levels of glucose, and recording of blood glucose results in logbooks. Timing

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