Understanding cognitive, emotional, and social aspects in diabetes (type 1) self-management in young adults

Background: Diabetes type 1 (T1D) is a chronic disease in which the pancreas produces
insufficient amounts of the hormone insulin. Patients must make complex decisions about self-management
behaviour to keep blood glucose levels within a safe range and reduce long-term
complications. Patients must follow an intensive regime of multiple insulin injections,
continuously adjusting insulin dosage depending on food intake, exercise, and other factors
while mood and cognition are affected by low and high glucose levels. The demanding nature of
diabetes often causes patients to experience diabetes-related distress. Young adults with T1D,
particularly university students, struggle to practice good self-management and are less likely to
seek medical support. This not only presents an increased risk of mental health challenges but
also factors into 26% of university students with diabetes being hospitalised due to diabetes
complications. My project aims to understand how young adults make decisions about taking
insulin or glucose when needed to treat low or high blood glucose levels. Psychology is key to
understanding this, because successful self-management depends on the cognitive ability and
resilient personality to deal with complex decisions and the effects of diabetes on mental health.
New available diabetes technologies (e.g., glucose sensors) have recently changed self-management,
but little to no research exists exploring why young adults don't use this
technology effectively. Additionally, there is no comprehensive understanding of what decisions
young adults make regarding diabetes self-management.

Research Questions: What does self-management
in young adult diabetes patients involve and how do they make decisions about
diabetes self-management? Why are these decisions not leading to the ideal safe range of blood
glucose values?

Methodology: This multi-methodology project will focus on young adults with
diabetes (N =80) completing 3 studies, as this is the adult age group experiencing most selfmanagement
problems. This was confirmed by my preliminary research in my final year
psychology thesis. Study 1 will analyse how young adults manage their diabetes using semistructured
interviews. The aim is to gain a detailed understanding of how students make
decisions about their self-management depending on different social and personal situations.
Study 2 will explore self-management behaviour and mood during different glucose levels over a
period of 2 weeks. Participants will record their glucose level, mood, and decisions in response to
their glucose level multiple times each day using an app. This will provide an in-depth insight of
psychological correlates of a variety of blood glucose values. For the period of the two-week
study, glucose sensor data will be collected. Study 3 will involve participants completing a
battery of cognitive tests to study how cognition is affected during different blood glucose levels.
This will be compared to a group of age and socio-economically matched healthy controls.
Impact This project will improve the field's understanding of the decisions young adults make in
response to glucose variations and why optimal self-management is difficult to achieve in this
cohort. The results will inform healthcare and university services on how to better support young
adults with diabetes live a healthy life during a high-risk period, in the hope of improving
wellbeing and reducing long-term complications.