PSYCHOLOGIC ASPECTS OF COMPLIANCE WITH THERAPY IN CHILDREN WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Cognitions (conceptual constructs) concerning treatment and compliance with treatment were investigated in 39 children with insulin-dependent diabetes mellitus (mean age, 13.8 +/- 3.0 years; duration of diabetes mellitus, 5.1 +/- 3.2 years). A structured interview and a scale exploring diabetes-related cognitions were administered to each child. Results were as follows: the complexity of treatment of IDDM was perceived as the main obstacle to compliance by 90 % of subjects; despite adequate knowledge of the prescribed treatment regimen, the children had created a mental representation of what their treatment should be and were highly compliant to this subjective construction. Most of the complex elements of therapy (urine and blood glucose monitoring, diet) were partly eliminated, with the child developing an idiosyncratic therapeutic regimen with which he or she complied scrupulously. The impact of patient education could be improved by taking this tendancy towards hypersimplification into account and by working out with the child the most acceptable regimen capable of ensuring optimal metabolic control.