Adherence to diabetes care: Knowledge of biochemical processes has a high impact on glycaemic control among adolescents with type 1 diabetes

Efrat Dagan, Ilana Dubovi, Milana Levy, Nehama Zuckerman Levin, Sharona T. Levy

Research output: Contribution to journalArticlepeer-review


Aim: To evaluate the impact of patients’ understanding of biochemical processes involved in glucose regulation (causal-biochemical knowledge) and of diabetes self-management knowledge on adherence to treatment recommendations among adolescents with type 1 diabetes mellitus. Design: A cross-sectional study. Methods: Adolescents with type 1 diabetes mellitus, aged 12–18 years and able to read and write in Hebrew or in Arabic were eligible. Participants were recruited between August 2016 – January 2018 during routine visits to the Paediatric Diabetes Clinic; informed consent was obtained as customary. Patients completed sociodemographic, clinical and type 1 diabetes mellitus self-management and biochemical knowledge questionnaires. Adherence to treatment was assessed by patients’ serum HbA1c levels, collected from medical records. Results: Ninety-seven patients participated in the study. Mean HbA1c levels were 9.2% (1.9%) and only 24 (24.7%) patients met the recommended HbA1c ≤ 7.5%. Lower HbA1c levels were strongly associated with higher family income, older age at diagnosis and with better type 1 diabetes mellitus self-management and causal-biochemical knowledge. A regression model showed that causal-biochemical knowledge contributed to the variance in HbA1c levels. Furthermore, causal-biochemical knowledge, but not self-management knowledge, was found to mediate the negative relationship between low family income and high HbA1c levels. Conclusions: Causal-biochemical knowledge is a valuable component for the adherence to diabetes care and glycaemic control. Impact: Our study suggests that causal knowledge is a valuable component that should be included in nursing and healthcare educational programmes for adolescents with type 1 diabetes mellitus.

Original languageEnglish
Pages (from-to)2701-2709
Number of pages9
JournalJournal of Advanced Nursing
Issue number11
StatePublished - 1 Nov 2019

Bibliographical note

Funding Information:
Funding information This study was funded by D-Cure, advancing diabetes care to cure fund, medical funds and the Israeli Ministry of Health, OTZMA project #3-12108 2808. We would like to express our deep gratitude to the adolescents and their parents for their efforts and for devoting their time, and for their willingness to participate in the study. We thank Ms. Yael Dishon Ben-Attar for her great help in all matters relating to the Helsinki approval of the study; to Ms. Heli Patito for her assistance in recruiting the patients and collecting the clinical data; to Ms. Christena Abuhani for her assistance in translating all study materials to Arabic and in recruiting the patients; and to Ms. Kristen Ebert-Wagner for English editing of the MS.

Publisher Copyright:
© 2019 John Wiley & Sons Ltd


  • HbA1c
  • adherence to treatment
  • adolescents
  • causal-biochemical knowledge
  • nursing
  • patient education
  • self-management knowledge
  • type 1 diabetes mellitus

ASJC Scopus subject areas

  • General Nursing


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