Factors Related to Compliance Among Adolescents with Diabetes Mellitus Type 1: A Non-Randomised Controlled Study of a Group Information and Peer-Discussion Programme

Objectives: This study explored factors related to treatment compliance among adolescents with type 1 diabetes mellitus (DMT1) in Lusaka, Zambia, and examined whether compliance was related to quality of life. The factors examined were the time at which insulin is taken, changes in insulin dosage, delays in meal timing, lapses in diet, physical exercise and hypoglycaemic episodes. The study also compared these factors between adolescents who received a group information and peer-discussion programme and a wait-list control group.
Methodology: This was a non-randomised controlled study with a wait-list control group. Forty adolescents aged 16 to 19 years who had been diagnosed with DMT1 within the previous six months were recruited at the Diabetes Association of Zambia (DAZ) Centre, University Teaching Hospital (UTH). They were allocated within strata of gender and age band by alternation (even or odd position on an alphabetical list) to either an intervention group (n = 20) or a control group (n = 20). The intervention comprised eight weekly one-hour sessions that combined diabetes information, access to clinic staff and participant-led group discussion.
Measures: A social demographic questionnaire, the Rating Scale for Compliance (RSC) and the Diabetes Quality of Life Scale modified for youths (DQOL) were administered at baseline (week 1) and follow-up (week 10).
Results: At baseline, the intervention group was less compliant than the control group (p = .001). At follow-up, the pattern reversed: all 20 adolescents in the intervention group reported taking insulin on time, making no unprescribed dose changes, keeping meals on time, having no diet lapses, exercising at least five times a week and having no hypoglycaemic episodes, compared with 45% to 75% of the control group on the insulin, meal, diet and hypoglycaemia items and 15% on exercise. The difference in total compliance at follow-up was large (p < .001; rank-biserial correlation 0.95, approximate 95% CI 0.85 to 1.00), and all 20 intervention participants improved from baseline (exact sign test, p < .001); a summary-level sensitivity analysis indicated that adjusting for baseline would increase, not reduce, the estimated advantage. At follow-up the intervention group also reported less impact of diabetes and fewer worries but lower satisfaction with life. Across both groups, better compliance was associated with better quality of life (r = 0.468, 95% CI 0.18 to 0.68, p = .002; lower scores are more favourable on both scales).
Conclusion: Adolescents who took part in the programme reported better compliance than the wait-list control group at follow-up, and better compliance was associated with better quality of life. Because allocation was not random, the groups differed at baseline, the programme had several components and all outcomes were self-reported, these findings are preliminary. They need confirmation in larger randomised multi-site trials that separate information from peer support and include objective measures such as HbA1c.

Adolescents, diabetes, compliance, factors, quality of life

1. Baren D, Yudkin JS, Courten M. Access to care for patients with insulin-requiring diabetes in developing countries: case studies of Mozambique and Zambia. Diabetes Care. 2005;28(9):2136-40. [Google Scholar] [Crossref]

2. Cameron FJ, Northam EA, Ambler GR, Daneman D. Routine psychological screening in youth with type 1 diabetes and their parents. Diabetes Care. 2007;30(10):2716-24. [Google Scholar] [Crossref]

3. Clarke D, Goosen T. Depression and compliance with treatment in a sample of Northland diabetes patients. N Z Med J. 2005;118(1222):1657. [Google Scholar] [Crossref]

4. Cliff N. Dominance statistics: ordinal analyses to answer ordinal questions. Psychol Bull. 1993;114(3):494-509. [Google Scholar] [Crossref]

5. Conover WJ, Iman RL. Rank transformations as a bridge between parametric and nonparametric statistics. Am Stat. 1981;35(3):124-9. [Google Scholar] [Crossref]

6. Court JM, Cameron FJ, Berg-Kelly K, Swift GFP. Diabetes in adolescence. Pediatric Diabetes. 2009;10(12):185-94. [Google Scholar] [Crossref]

7. Daneman D. Type 1 diabetes. Lancet. 2006;367:847-58. [Google Scholar] [Crossref]

8. DCCT Research Group. Reliability and validity of a diabetes quality-of-life measure for the Diabetes Control and Complications Trial (DCCT). Diabetes Care. 1988;11(9):725-32. [Google Scholar] [Crossref]

9. De Jong, Bennink. You, Me and Diabetes. Kids and care. Johannesburg, South Africa; 2006. [Google Scholar] [Crossref]

10. de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes. 2022;23(8):1373-89. [Google Scholar] [Crossref]

11. Delamater AM. Improving patient adherence. Clinical Diabetes. 2006;24(2):71-7. [Google Scholar] [Crossref]

12. Des Jarlais DC, Lyles C, Crepaz N; TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004;94(3):361-6. [Google Scholar] [Crossref]

13. Fidler C, Gillard S. Hypoglycemia: an overview of fear of hypoglycemia, quality of life, and impact on costs. J Med Econ. 2011;14(5):646-55. [Google Scholar] [Crossref]

14. Frank MR. Psychological issues in the care of children and adolescents with type 1 diabetes. Paediatr Child Health. 2005;10(1):18-20. [Google Scholar] [Crossref]

15. Graue M, Wentzel-Larsen T, Bru E, Hanestad RK, Sovik O. The coping styles of adolescents with type 1 diabetes are associated with degree of metabolic control. Diabetes Care. 2004;27(6):1313-7. [Google Scholar] [Crossref]

16. Grayson NH. A developmental perspective on adolescent health and illness: an introduction to the special issues. J Pediatr Psychol. 2002;27(5):409-16. [Google Scholar] [Crossref]

17. Guthrie WD, Bartsocas C, Chabot JP, Konstantinova M. Psychosocial issues for children and adolescents with diabetes: overview and recommendations. Diabetes Spectrum. 2003;16(1):7-12. [Google Scholar] [Crossref]

18. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29-36. [Google Scholar] [Crossref]

19. International Diabetes Federation. IDF Diabetes Atlas. 4th ed. Brussels: International Diabetes Federation; 2009. [Google Scholar] [Crossref]

20. International Diabetes Federation. IDF Diabetes Atlas. 5th ed. Brussels: International Diabetes Federation; 2011. [Google Scholar] [Crossref]

21. International Diabetes Federation. IDF Diabetes Atlas. 11th ed. Brussels: International Diabetes Federation; 2025. Available from: https://diabetesatlas.org [Google Scholar] [Crossref]

22. Ingersoll GM, Marrero DG. A modified quality-of-life measure for youths: psychometric properties. Diabetes Educ. 1991;17(2):114-8. [Google Scholar] [Crossref]

23. Kyngäs HA. Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus). Chronic Illn. 2007;3(1):20-8. [Google Scholar] [Crossref]

24. Lewin A, Heidgerken A, Geffken G, Williams L, Storch E, Gelfand K, Silverstein J. The relation between family factors and metabolic control: the role of diabetes adherence. J Pediatr Psychol. 2006;31(2):174-83. [Google Scholar] [Crossref]

25. Majaliwa ES, Elusiyan EJ, Adesiyun OO, et al. Type 1 diabetes mellitus in the African population: epidemiology and management challenges. Acta Biomed. 2008;79:255-9. [Google Scholar] [Crossref]

26. Novato TS, Grossi SAA. Factors associated to the quality of life of adolescents with type 1 diabetes mellitus. Rev Esc Enferm USP. 2011;45(3):770-6. [Google Scholar] [Crossref]

27. Novato TS, Grossi SAA, Kimura M. Quality of life and self-esteem of adolescents with diabetes mellitus. Acta Paul Enferm. 2008;21(4):562-7. [Google Scholar] [Crossref]

28. Obasi CC. Understanding diabetes mellitus. Zambia: Smack Trading Company Limited; 2006. [Google Scholar] [Crossref]

29. Patton S. Adherence to treatment in children and adolescents with type 1 diabetes mellitus. US Paediatric Review. 2006. [Google Scholar] [Crossref]

30. Pereira GM, Berg-Cross L, Almeida P, Machado CJ. Impact of family environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes. Int J Behav Med. 2008;15:187-93. [Google Scholar] [Crossref]

31. Taddeo D, Egedy M, Frappier J. Adherence to treatment in adolescents. Paediatr Child Health. 2008;13(1):19-24. [Google Scholar] [Crossref]

32. Vickers AJ, Altman DG. Analysing controlled trials with baseline and follow-up measurements. BMJ. 2001;323(7321):1123-4. [Google Scholar] [Crossref]

• Measuring Waste of Patient Time in Health Care at Non-Digitized Hospital: An Observational Study in Bangabandhu Sheikh Mujib Medical University, Bangladesh
• Reaffirming Clinical Confidence in Atorvastatin Therapy: A Digital Outreach Case Study from Tamil Nadu, India
• Clinical Manifestations and Therapeutic Response in a Patient with Hypothyroidism: A Case Report
• Eranda (Ricinus Communis) In Gridhrasi (Sciatica): Classical Rationale, Pharmacology and Clinical Evidence- A Narrative Literature Review
• Magnetotherapy in Pain Management: Mechanisms, Clinical Applications, and Future Perspectives – A Review