The Three I's of Diabetes Integration in Emerging Adulthood—Developing a Framework to Individualize Diabetes Care

Transition of care occurs within the developmental context of emerging adulthood (EA; 18-24 years), in which diabetes self-management is challenged as an individual learns to cope with diabetes and develop their independence. With the goal of helping providers individualize support as patients begin adult care, we conducted a qualitative study with 33 emerging adults with type 1 diabetes (51% female, age 20.6±0.3 years, diabetes duration 12±1 years). Individual semi-structured interviews allowed participants to depict their lived experiences with diabetes. We employed a narrative approach to the analysis of interview transcripts and constant comparison was used to identify similarities and differences in narrative typology and thematic content. We identified that participants’ accounts of living with diabetes could be grouped into three broad categories: Ingrained (n=14), Intrusive (n=12) and Inconspicuous (n=7). We interpreted these accounts as different “lenses” through which individuals perceive their diabetes during EA. Participants conveying an Ingrained lens perceived diabetes to be comfortably settled within their daily lives and described self-confidence for management. Participants conveying an Intrusive lens perceived diabetes as disrupting their daily living and described moral sensitivity towards management (i.e., being seen as a ’good’ or ’bad’ self-manager). Participants conveying an Inconspicuous lens told stories that demonstrated their efforts to minimize their diabetes and described disregard for management. HbA1c levels were lower in participants conveying an Ingrained lens (HbA1c (%), Ingrained 7.4±0.2, Intrusive 9.3±0.5 (p<0.01 vs. Ingrained), Inconspicuous 8.4±0.3). Although movement between these domains may be fluid, mixed or incomplete, this framework provides a heuristic strategy to recognize emerging adults’ varying views of their diabetes and presents opportunities for individualizing care accordingly. Disclosure B. Markowitz: None. C. Pritlove: None. G. Mukerji: None. J.V. Lavery: None. J.A. Parsons: None. A. Advani: Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. Other Relationship; Self; Boehringer Ingelheim GmbH.