The health and lifestyles of adolescents with type 1 diabetes in Portugal

The purpose of this article is to describe the compliance of adolescents with diabetes and some factors connected to it. Altogether, 300 individuals aged 13 to 17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Ninety-seven percent (N = 289) of the adolescents with diabetes returned the questionnaire. The data were analyzed by using the Statistical Package for the Social Sciences (SPSS) software. Only about one fifth (19%) of the respondents with diabetes felt that they complied fully with the health regimens, whereas 75% placed themselves in the category of satisfactory compliance and the remaining 6% reported poor compliance. Compliance with home monitoring was poorest: Only 25% said they fully complied with the home monitoring instructions, and 51% showed poor home monitoring compliance. The highest degree of compliance was reported for insulin treatment, with 81% of the patients ranking in the top category. Some statistically significant (p < .001) relationships between the degree of compliance and the background variables, such as the duration of disease; exercise; smoking; alcohol intake; and serum glycosylated hemoglobin (GHbA1c) value, were found. Good motivation, a strong sense of normality, energy and willpower, support from parents; physicians; and nurses, a positive attitude toward the disease and its treatment, no threat to one's social well-being, and fears of complications explained good compliance (p < .001).

The study involved 2,101 adolescents, aged 10–18 years, from 21 centres in 17 countries in Europe, Japan and North America. Adolescent quality of life (QOL) was assessed by a previously developed Diabetes Quality of Life Questionnaire for adolescents (DQOL), measuring impact of diabetes, worries about diabetes, satisfaction with life and health perception. Parents and health professionals assessed ‘family burden’ using newly constructed questionnaires. Mean HbA 1c was 8.7% (range 4.8–17.4%). Lower HbA 1c was associated with lower impact (p 1c was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.

Most multicentre studies demonstrate that the outcome of diabetes therapy falls below the targets set up in recent guidelines. Applying quality control methodology may provide one means better to achieve such targets. Before setting up a quality circle, objective, standardized documentation of relevant quality indicators is necessary. Based on internal (for example longitudinal changes over time) and external quality control (comparison with other institutions), both favourable and unfavourable results achieved by each institution are identified. Such data provide the basis for intensive discussion among the members of diabetes care teams on how to remedy such deficits. In Germany, the working group on paediatric diabetology set up a system for external quality assessment in 1995: For 6 continuous years, quality indicators are compared twice yearly, and regional quality circles for more open discussions have been established, in addition to yearly nationwide meetings among all participants.