Illness Identity in Pediatric Type 1 Diabetes: An Examination of Mechanisms and Outcomes

Type 1 diabetes (T1D) is the most common metabolic disorder in youth, and incidence is increasing. A growing body of literature has identified adolescence as a developmental stage, in which risk for poor health-related outcomes is highest. Despite this elevated risk for negative health-related outcomes, many adolescents with T1D thrive and achieve positive health-related outcomes; it is critical to study youth who flourish in the context of T1D to better support youth who are struggling. In the context of various biological and psychosocial changes, one notable change that occurs during adolescence is identity development, raising question about how adolescents with T1D integrate their illness into their sense of self. Illness identity, the degree to which one integrates a chronic condition into their identity, may be important. Despite the limited literature, data suggest that illness identity is associated with various health-related outcomes, like glycemic stability and health-related quality of life (HRQoL), in pediatric T1D. Thus, consistent with Hilliard et al.’s (2012) diabetes resilience model, illness identity may be conceptualized as an individual risk or asset that predicts behavioral and general resilience, which in turn, predicts health-related outcomes. The overall aim of the current study was to examine the relationship between integration of T1D into identity, diabetes management, response to stress, glycemic stability, and HRQoL. Results indicated that greater integration positively predicted HRQoL, and this relationship was partially mediated by response to stress, such that increased integration predicted a reduced response to stress, which in turn, predicted better HRQoL. Data also highlighted that greater systemic disadvantage (i.e., systemic inequities) predicted reduced glycemic stability; this highlights the importance of assessing social determinants of health in the context of routine healthcare visits. Additional future directions and clinical implications are discussed.