The purpose of a study by Mulvaney and coworkers was to determine barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes. Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, six focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Trained group facilitators asked questions. Three reviewers coded transcripts and qualitative analyses were conducted. A total of 24 adolescents participated in six focus groups. Coding resulted in four common domains affecting self-management: (1) adolescent psychosocial development; (2) the role of others with diabetes; (3) environmental influences; and (4) adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Mulvaney and colleagues concluded that their results suggested that improving self-management in adolescents might require multimodal interventions to address individual, family, and social processes.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The barriers and facilitators identified in the study should be considered by anyone with diabetes who performs self-management skills. Adjusting your program to eliminate the barriers and incorporate the facilitators will likely make you more effective at managing your diabetes.

SA Mulvaney et al. Self-management in Type 2 Diabetes: The Adolescent Perspective. Diabetes Education, 2008;34:674-682.