Topical review: A conceptual framework for diabetes distress tolerance in transitional age youth with type 1 diabetes

Approximately one-third of adolescents with type 1 diabetes (T1D) experience substantial diabetes distress, which is longitudinally associated with worsened glycemic control. This is particularly consequential given the inverse relationship between diabetes distress and healthcare transition readiness. Interventions for distress may seek to either reduce it or increase capacity to tolerate it; however, diabetes-specific distress tolerance remains insufficiently conceptualized in the research literature. The purpose of this topical review is to propose a conceptual framework for examining diabetes-specific distress tolerance in transitional age youth with T1D, which may further inform measure development and interventions to increase diabetes distress tolerance, enhance transition readiness, and improve longitudinal health outcomes.

We review literature on diabetes distress in transitional age youth with T1D, focusing on effective interventions to reduce diabetes distress, including relevant literature on the related construct of distress tolerance. We then integrate this literature to propose a conceptual framework of diabetes distress tolerance that may inform the development of interventions to improve transition readiness and health outcomes for transitional age youth with T1D.

Existing diabetes distress interventions for transitional age youth with T1D have primarily targeted skills to reduce distress, rather than increasing capacity to tolerate it. Distress tolerance is an understudied construct in relation to T1D management.

We propose a conceptual framework of diabetes distress tolerance that may inform intervention development to address diabetes distress for youth with T1D. Given transition-associated risks of adverse outcomes, more research is needed to address diabetes distress tolerance in transitional age youth with T1D.