Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.733853
Title: 'Living well' with insulin-dependent diabetes in adolescence
Author: Welsh, A.
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Abstract:
Chapter One is a systematic review that aims to investigate the relationship between glycaemic control and quality of life (QoL) in adults with Type 1 Insulin-Dependent Diabetes Mellitus (IDDM). The National Institute for Health and Care Excellence (NICE, 2015) proposes that adults with IDDM should aim to achieve a near-normal glycaemic range, as indicated by the measurement of glycated haemoglobin (HbA1c), to reduce the risk of severe life-changing complications. Anecdotally, in clinical practice, it is assumed that those who achieve good glycaemic control and meet the required HbA1c target also have good QoL; however, striving for a near normal HbA1c, and the associated treatment burden, may have a negative impact upon QoL. The negative impact of treatment burden on QoL may be a necessary compromise, as achieving a near normal HbA1c is likely to safeguard the person from IDDM- related complications in the long-term, which will inevitably impact upon QoL later (Rubin & Peyrot, 1999). Therefore, it is not yet established how achieving a near-normal HbA1c impacts upon QoL. These issues were brought to life clinically, as the lead researcher spent time in the Paediatric Diabetes Department, and this fuelled their interest in investigating the relationship between HbA1c and QoL in adults with IDDM. Seven studies are included in the review. Few studies set out to investigate the relationship between HbA1c and QoL. The overall quality of the research is poor. Three of the seven studies indicated that there was no relationship between HbA1c and QoL, one study identified a negative correlation, one study offered mixed results, and two studies proposed that a curve-linear relationship best described their data. Therefore, the review is unable to provide a conclusive statement regarding the nature of the relationship between HbA1c and QoL. The review does not support the commonly held anecdotal assumption that good glycaemic control, as indicated by HbA1c, equates to good QoL. Furthermore, the review highlights the limitations of quantitative research design and methodology when investigating a subjective and dynamic phenomenon such as QoL. The limitations found in the quantitative studies included in the systematic review informed the design of the empirical investigation that employs qualitative methods. Chapter Two is an empirical paper that describes a qualitative study that explored how adolescents aged 13 to 19 with IDDM experience themselves as able to 'live well' despite their chronic condition. IDDM is one of the most common childhood conditions in the UK, and it requires careful management to reduce the risk of life limiting and life changing complications (Spencer, Cooper & Milton, 2010). As with adults, UK healthcare policy proposes that young people aim to achieve near normal glycaemic control to reduce the risk of IDDM complications (NICE, 2015). Adolescents with IDDM typically have poor glycaemic control and this poses a significant challenge to diabetes healthcare teams (Burke & Dowling, 2007). The extant literature explores 'barriers' to control and focuses upon the negative impact of IDDM; it is 'problem saturated' (Balfe et al., 2013). The purpose of this paper was to explore qualitatively how some young people are able to experience themselves as living well in adolescence despite IDDM. In contrast to the systematic review of quantitative research regarding HbA1c and QoL in adults, this paper uses a qualitative design that specifically explores the experiences of adolescents; a population who generally have poor control. Furthermore, it is hoped that this positive psychological approach will address a gap in the literature and may help deepen the understanding of the psychological and social processes that enable some young people to live well with a chronic condition. The lead researcher has a longstanding interest in working with adolescents.a subjective and dynamic phenomenon such as QoL. The limitations found in the quantitative studies included in the systematic review informed the design of the empirical investigation that employs qualitative methods. Chapter Two is an empirical paper that describes a qualitative study that explored how adolescents aged 13 to 19 with IDDM experience themselves as able to 'live well' despite their chronic condition. IDDM is one of the most common childhood conditions in the UK, and it requires careful management to reduce the risk of life limiting and life changing complications (Spencer, Cooper & Milton, 2010). As with adults, UK healthcare policy proposes that young people aim to achieve near normal glycaemic control to reduce the risk of IDDM complications (NICE, 2015). Adolescents with IDDM typically have poor glycaemic control and this poses a significant challenge to diabetes healthcare teams (Burke & Dowling, 2007). The extant literature explores 'barriers' to control and focuses upon the negative impact of IDDM; it is 'problem saturated' (Balfe et al., 2013). The purpose of this paper was to explore qualitatively how some young people are able to experience themselves as living well in adolescence despite IDDM. In contrast to the systematic review of quantitative research regarding HbA1c and QoL in adults, this paper uses a qualitative design that specifically explores the experiences of adolescents; a population who generally have poor control. Furthermore, it is hoped that this positive psychological approach will address a gap in the literature and may help deepen the understanding of the psychological and social processes that enable some young people to live well with a chronic condition. The lead researcher has a longstanding interest in working with adolescents.
Supervisor: Kiemle, G. ; Unwin, J. Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.733853  DOI:
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