highly compliant. This belief is so ingrained that physicians commonly use glycosylated hemoglobin assay results as an indicator of patient adherence ( Clarke et al., 1985). Yet, our and others' data do not support this assertion. Although we may not yet be able to definitively answer the question, "does behavior make a difference?", we certainly need to emphasize the importance of asking that question. Physician beliefs about powerful links between adherence behaviors and diabetes control have important implications for patient care. If poor control means poor adherence to the doctor, the patient may be blamed for his or her medical condition. The physician may do little to change the patient's medical prescription because the patient is seen as the source of the problem. In turn, the patient may develop feelings of discouragement and resentment, particularly if sincere efforts have been made to adhere to the medical regimen. It is probably best for all concerned if we emphasize the importance of the question rather than the definitiveness of its answer.
This chapter was supported by grants #R01 HD 13820 and K04 HD 00686 from the National Institute of Child Health and Human Development.
Amiel S. A., Sherwin R. S., Simonson D. C., Lauritano A. A., & Tamborlane W. V. ( 1986). "Impaired insulin action in puberty: A contributing factor to poor glycemic control in adolescents with diabetes". The New England Journal of Medicine, D I,215-219.
Anderson B. J., Wolf F. M., Burkhart M. T., Cornell R. G., & Bacon G. E. ( 1989). "Effects of peer-group intervention on metabolic control of adolescents with IDDM: Randomized outpatient study". Diabetes Care 12,179-183.
Barrett-Conner E., & Orchard T. ( 1985). "Diabetes and heart disease". In M. Harris & R. Hamman (Eds.). Diabetes in America (pp. XVI: 1-41). (NIH Publication No. 85- 1468). Washington, DC: U.S. Department of Health and Human Services/Public Health Service.
Brownlee-Duffeck M. Peterson L., Simonds J. F., Goldstein D., Kilo C., & Hoette S. ( 1987). "The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus". Journal of Consulting and Clinical Psychology, 5,139-144.
Carney R. M., Schechter K., & Davis T. ( 1983). "Improving adherence to blood glucose testing in insulin-dependent diabetic children". Behavior Therapy, 14,247-254.
Christensen N. K., Terry R. D., Wyatt S., Pichert J. W., & Lorenz R. A. ( 1983). "Quantitative assessment of dietary adherence in patients with insulin-dependent diabetes mellitus". Diabetes Care, 6,245-250.
Clarke W. L., Snyder A. L., & Nowacek G. ( 1985). "Outpatient pediatric diabetes-1. Current practices". Journal of Chronic Diseases, 38,85-90.
Cox D. J., Taylor A. G., Nowacek G., Holley-Wilcox P., & Pohl S. L. ( 1984). "The relationship between psychological stress and insulin-dependent diabetic blood glucose control: Preliminary investigations". Health Psychology, 3,63-75.