Peers may influence how well type 1 diabetes is managed

26 December 2017: How young people with type 1 diabetes relate to their peers may have important effects on how well they manage the disease and how distressing it is for them, a small study suggests.

Peers can help teens and young adults accept their disease and follow their treatment plans, but youth who are too attuned to what their friends think of them may neglect disease management to fit in, the authors report in Diabetes Care.

“This was one of the first studies to ask adolescents and emerging adults with type 1 diabetes about their relations with peers at a certain point in time and one year later,” lead author Koen Raymaekers from the University of Leuven in Belgium told Reuters Health by email.

“We found that more general positive relations with peers at one point in time predicted less diabetes-specific distress one year later,” he said.

But, because young adults who were very oriented toward peers at the start had worse blood sugar control a year later, paying additional attention to peer relations during this time seems important, Raymaekers added.

The researchers recruited more than 400 Dutch-speaking young people in Belgium, aged 14 to 25, with type 1 diabetes. The participants answered questionnaires rating how they felt about the support they got from their peers as well as their perceptions of their parents’ responsiveness to their needs.

The study team also measured “peer orientation” - whether participants were more likely to listen to their parents or to their peers - with questions such as, “Would you ignore your diabetes management needs in order to make someone like you?”

The researchers had access to long-term blood sugar measurements and the young people answered questions about their treatment adherence as well as their diabetes-related distress levels.

The study team found that having supportive peers was associated with less diabetes-related distress over time. But, having extreme peer orientation was associated with greater treatment distress over time and poorer blood sugar control.

Conversely, good treatment adherence was tied to lower peer-orientation scores, less treatment distress and better blood sugar control.

Youth who reported having more responsive parents tended to have less food distress over time, the researchers also found.

“Our study indicates that as a parent/grandparent/caregiver it may be informative to ask about patients’ peer relations,” Raymaekers said.

If patients indicate that they experience difficulties with peer relations this may have an impact on their diabetes-related distress and perhaps even on treatment adherence and blood sugar control in the long term, he said.

“In addition, some patients may experience their diabetes as a burden when interacting with peers, and therefore neglect treatment in favor of fitting in with peers,” Raymaekers noted.

Therefore, he said, when there are indications of problematic relations with peers, as a parent/grandparent/caregiver one could think and talk with the patient on how to improve these relations without sacrificing treatment or feeling distressed by their diabetes.

Raymaekers added that he was not surprised to see that peers are important for patients with type 1 diabetes, but there were some specific “rather striking” findings, for example, that the 18-24 year olds who were very oriented toward peers at baseline had worse blood sugar control one year later.

There is a need for more research on this topic, which could uncover the cause and effect relationships between peer relationships and diabetes outcomes and the mechanisms at work, he said.