Resilience is linked to HbA1c levels in young adults with type 1 diabetes: a mixed-methods pilot study

Young people with type 1 diabetes frequently find it difficult to adjust to and deal effectively with their condition as evidenced by poor glycemic control. This problem has been identified in many countries, but is pronounced in England in the 16 - 25 age group. Reasons for this problem are unclear. Resilience, understood as adaptive and effective handling of adversity, has been suggested as a protective factor by psychologists and neuroendocrinologists. This pilot explored the question to what extent and how members of this age group with either good or poor glucose control differ with respect to resilience and correlated factors including social support, attachment and emotional health. A cross-sectional mixed methods recruited 41 young adults (target n=40) who demonstrated either good or poor HbA1c levels (defined as HbA1c screen values of < 58 or > 75 mmol/mol respectively) from 2 secondary care centers in England. The sample included 21 women; mean age was 19.7 years. Standardized questionnaires, demographic and health and illness related questions were used. A subset of participants (n=21) took part in semi-structured interviews and filled in event diaries (n=11). Ethical approval was granted; participants were recompensed. Stronger resilience amongst those who had lower HbA1c values was observed (P < .0005). Better social support was associated with a lower HbA1c (emotional support p = .007; practical support p = .02). Wellbeing and attachment style were not associated with HbA1c (p > 0.1). Qualitative findings illustrate how diabetes is negotiated in everyday life, how it shapes identity and promotes a sense of agency where young people actively take control of their own situations. Self-management of diabetes involves an understanding of transitions and pathways through the condition and its medical implications, alongside the notion of embodied self-care. In conclusion, resilience, in conjunction with social support, should be explored in a larger longitudinal study.