“Diabetes is really simple on paper, but really complicated when you actually have it”: Understanding the daily stressors of adolescents living with Type 1 diabetes

Abstract

Purpose:

This study aims to explore the daily stressors experienced by adolescents with Type 1 diabetes (T1D) and the perceived impact of those stressors on their self-management and psychological well-being.

Design and Methods:

We conducted semistructured in-depth telephone interviews using a qualitative descriptive approach with 20 adolescents aged 14–17 years with T1D and analyzed subsequent data using thematic analysis.

Results:

Participants who were non-Hispanic white made up 85% of the sample, 75% identified as female and mean age was 15 years. The study identified two key themes: “the everyday stress of living with diabetes” and “managing stress and supporting psychological well-being.” Participants described heightened mental load, the impact of daily activities, stress associated with public diabetes management, and added stress due to COVID-19. Primary mitigation techniques included family support, peer support networks, activity engagement, and personal acceptance of their condition.

Practice Implications:

We found that there is a compound effect that occurs with balancing daily disease management with normative activities of daily living. These data will help guide the design of new interventions and tailoring of existing interventions. Future intervention development may include physical exercise, mindfulness training, and stress reducing techniques.

1 |. INTRODUCTION

Type 1 diabetes (T1D) is an autoimmune disease in which the pancreas is unable to produce insulin (Centers for Disease Control and Prevention, 2023b). T1D is a chronic, lifelong condition requiring daily administration of multiple insulin injections titrated with diet and exercise (Centers for Disease Control and Prevention, 2023b). T1D is usually diagnosed before the age of 18, with diagnosis peaking at ages 13 to 14 years (Centers for Disease Control and Prevention, 2023a).

General daily management of T1D includes constant monitoring of blood glucose, administering insulin by pump and/or injection, meal planning, recordkeeping, and complex problem solving (Shubrook et al., 2018). These daily management tasks for children and adolescents can take an average of 78 min per day and up to 5 h per day (Shubrook et al., 2018). When considering various aspects of care including hypoglycemic and hyperglycemic episodes during school hours, medication and meal planning for school, participation in extracurricular activities, ordering medical supplies and medications, and scheduling appointments, daily management often feels like a second full-time obligation (Shubrook et al., 2018).

The chronic, complex nature of T1D often leads to increased stressors associated with disease management. Diabetes-related distress refers specifically to living with T1D and the associated daily, ongoing management of T1D (Hagger et al., 2016). Almost a third of adolescents with T1D report diabetes-related stress and distress (Hagger et al., 2016). Adolescents experience stressors related to school and social life, and then those stressors are compounded with T1D, putting them at an increased risk for negative psychosocial outcomes associated with the experience of living with chronic and meaningful daily stressors (Chao et al., 2016; Rechenberg et al., 2018). Elevated levels of both general and diabetes-specific stress in adolescents are associated with elevated hemoglobin A1C and poor self-management (Rechenberg et al., 2017).

T1D represents a lifelong diagnosis and requires significant day to day management tasks for optimal outcomes (Rechenberg et al., 2017; Shubrook et al., 2018). Adolescents with T1D experience stressors associated with their developmental stage (Chao et al., 2016; Hedge et al., 2023; Jaser et al., 2017), and are transitioning to independent management of their diabetes, which is often associated with additional stress and family conflict on top of the already complex requirements of the disease (Brazeau et al., 2018; Ersig et al., 2016; Karavanaki et al., 2023). To best understand how to develop interventions aimed at stress reduction and improving T1D self-management in adolescents, we aimed to explore how adolescents perceived and described the daily stress of living with diabetes and how those stressors impact their general daily management and lifestyle.

2 |. METHODS

2.1 |. Design

Participant demographics and characteristics were collected and displayed in Table 1. These characteristics include their hemoglobin A1c levels and whether they used injections or an insulin pump. We used a qualitative descriptive approach (Sandelowski, 2010) to describe the experience of stress in the daily lives of adolescents ages 14–17 living with T1D. An in-depth, semistructured telephone interview consisting of 10 open-ended questions was used (Tables 2 and 3). The average duration was 35 min. Telephone interviews have been established as a reliable way of collecting qualitative data (Novick, 2008).

TABLE 1.

Participant demographics.

Characteristic	N or M	% or SD
Gender
Female	15	7%
Male	5	25%
Age
Age (years)	15.10	3.73
Race/ethnicity
White, non-Hispanic	15	75%
White, Hispanic	2	10%
Asian, non-Hispanic	2	10%
Other, Hispanic	1	0.05%
School year
9th grade	6	30%
10th grade	8	40%
11th grade	5	25%
12th grade	1	0.05%
Household incomea
<34,999	-	-
$35,000–45,999	2	10%
$50,000–74,999	-	-
$75,000–99,999	6	30%
>$100,000	9	45%
Diabetes characteristics
Age diagnosed	8.98	3.73
Hemoglobin A1c level	7.62	1.39
Diabetes managementa
Pump	15	75%
Injection	4	20%

^aMissing data due to participants’ nonresponse.

TABLE 2.

Everyday stress of living with diabetes.

Master theme	Subtheme	Supporting quotes
Increased mental load of management tasks	Continuous mental burden	It can be stressful sometimes’cause that’s when diabetes is—until there is a cure, there’s always that thought in the back of your mind, throughout your day it affects all your choices… I’ve always got it on my mind… I think about my blood sugar. If I’m doing an activity, is my blood sugar low? If I’m just sitting around, is it too high? Do I have all the medical things that I need in my purse? Do I have tabs? Do I have test strips? Do I have juice? Do I have insulin?
	Stress of continuous calculations	Just the fact that it’s always there. It’s, in a way, kinda always watching you, but you will never really be able to avoid it. You’ll always have to check your blood sugars, and it just gets—and take insulin and do the math for that. It just gets overwhelming…
	Feeling continuous uncertainty	There’s a lot of things that can affect your numbers. Maybe your insulin isn’t working as well. Maybe your insulin’s about to expire, and you don’t know. Your numbers will go high if you’re stressed out at the party, maybe. For whatever reason, you can still go high…I think some of the reasons why it’s stressful is it’s just unpredictable sometimes.
Impact on daily activities	Impact on physical activities	With sports, I do—I play three sports. Each one is pretty different, so managing my different numbers and the different settings I need on my pump with each different sport is pretty stressful. The thought of not going low during my games and stuff like that is pretty stressful…
	Impact on school	You have to pay attention to the teacher, take notes, make sure you have all your homework ready, and all that other stuff. When you have to just take trips to the nurse’s office over and over again, you really miss a lot of school…You’re in the middle of a class. You’re not on your phone. You don’t know your numbers. Then all of a sudden, your alarm goes off that you’re super high, and now you have to go to the nurse’s office and miss school. It just repeats like that. Yeah, I think school is probably the main thing that makes diabetes a lot more difficult.
	Impact on sleep	Overnight is probably stressful, too, because waking up at 5:00 in the morning to take tabs or I’ve got a correction. It’s is pretty stressful, I would say, ‘cause I just wanna sleep…
Embarrassment and stress of public management	Embarrassment with management devices	After all the time in the middle of class, I’d be high, and then my alarm would go off, and I’m really, really high. Then it’s embarrassing’cause a lot of people will say, “Hey, just turn your ringer off, dude. What are you doing?”‘Cause, it’s a really loud beep, and it’s pretty embarrassing.
	Embarrassment with management in public places	I do deal with it whenever I have to. It’s just I’d rather do it in private. I’d rather go to the bathroom and give myself a shot if I had to do it in front of people. I just don’t like to feel left out or different. I don’t know… Sometimes, I’ll just go to the bathroom, and I’ll just do it in there.
	Stress related to explaining devices to others	Even with my Omnipod, I can’t go through metal detectors. Obviously not now in the pandemic, but before, going to a theme park or something, it’s always stressful because we go, I’m in my head like, “Okay. I know that I’m gonna have to tell someone that works there I can’t go through. Then, I’m gonna have to go somewhere else. They’re gonna have to scan me.”
COVID-19 risk and social isolation	Fear due to increased risk of severe illness	More stressful because I’m high risk ‘cause diabetes is a compromised immune system, so that stressed me out that COVID’s gonna affect me worse than everybody else so my friends they have it, they don’t feel good or whatever, but if I have it, it’s gonna hit me ten times harder.
	Increased social isolation	When I first found out COVID … I got really scared because they were saying that people with diabetes can get affected more, and they have a greater chance of being affected. I got really scared to go out. It’s like I didn’t go to practice. Of course, practice was closed, but even when it did open, I didn’t go for a while ‘cause I was still scared.
	Stress of supply shortages and delays	There was a problem when I ran out of sensors and I couldn’t get sensors for another six weeks for my G6 to track my blood sugar. My dad knew a friend who like I was saying one of the boys has type one diabetes, one of our neighbors. I never really talked to him, but my dad was like, “Hey, can we have a G6, ‘cause I know you use that same kind of technology. Can I have a G6?”

TABLE 3.

Managing stress and supporting psychological well-being.

Master theme	Subtheme	Supporting quotes
Family Support with Diabetes management, emotional well-being	Support with management	I remember it was around my second class. I wasn’t feeling well. I normally go low in that class. I went to test. I was looking, and my bag was empty. My pump wasn’t in it at all. I was like, “Oh my gosh. What am I gonna do now?” I went to the office. I called. Luckily, my dad was able to bring it. It took some time to get there, but I got very lucky.
	Relief from parental monitoring	There’s also a share app for parents or guardians or whoever wants to see your blood sugars, so they have that and they can see what my blood sugars are, so if I’m in a test or during school and not able to pay attention to it, they can text and tell me if I need to give insulin or eat a snack if I’m trending down.
	Educational support	I have gotten, not really in trouble, but I have gotten spoken to before [about missing school], but my parents are on top of things, so if something happens, they email the teacher and the school right away to clear things up.
	Emotional support	As long as I’m with someone like family, then I’ll feel calmer and safer… It’s the feeling that they’re there to help me and help me feel better.
	Need for independence	My mom does offer help and support, but she does also need to recognize I can’t be dependent on someone, as I do need to do it on my own.
Peer Support from those who “get it”	Support from educated, close friends	They took the time to listen to me and educate themselves in the basics of it, so they know that I need to do this and that I need to check my blood sugar, put my carbs in. Also, I’ve had multiple friends be like, “Can I check your blood sugar for you?” which I think is so funny because they’re like, “I wanna clean your finger, and I wanna poke you.”
	Support from others with T1D	Because it’s relatable, and we both know what each other are going through. I was actually friends before he had diabetes, then he got diabetes earlier this year. I think we both felt like we really helped each other out in that sort of way because we both related to things that no one else could relate to.
Engaging in enjoyable, calming activities	Physical activities	I definitely would take out frustration and stuff, a new hobby I recently explored was tennis. The activity also keeps my blood sugar at a normal level. It all goes hand in hand.
	Finding distractions	[Video games] help with stress… ‘cause you have to focus on the game instead of whatever you were stressing about.
	Clearing the mind	This is gonna sound very generic, but I just take deep breaths and just try to calm myself down, just to see if that can make me feel better, and then I try to really reason through what’s going on and what I need to do to bring my blood sugar down.
Personal acceptance of T1D	Improved acceptance over time	Well, I was just gonna say that it was definitely really hard at the beginning. There’s a lot of things that just gotten used to. That it’s become a daily thing. It’s just part of my life now.
	Being open with others	Well, one thing that helps make my anxiety better was, I think just being more open with my Type 1 diabetes, because I feel like the more I told my friends and my family and informed them, like, “This is what you need to do if something does happen,” or, “I’m low right now. I need to do this.” I felt like I felt more comfortable in my atmosphere and knowing that I was with people that knew what to if a situation were to happen.
	Appreciation of T1D	Honestly, I’m kind of thankful for it because it really has helped me. I’ve had to mature a lot faster and be more responsible for things.

Abbreviation: T1D, Type 1 diabetes.

2.2 |. Sample and setting

Adolescents were approached via online advertisements posted on social media web sites. Interested participants contacted the study team via email or phone to discuss the study and determine eligibility. Participants eligible for the study were: (1) 14 to 17 years of age; (2) diagnosed with T1D for at least 6 months; (3) without other chronic medical conditions requiring intensive daily management; (4) not currently participating in other studies; and (5) able to read and speak English fluently. We selected adolescents 14 to 17 years of age to capture early and middle adolescence, as this age span coincides with the period when self-management and glycemic control decline. We continued interviewing until data saturation was achieved.

2.3 |. Variables and measures

We collected demographic data, including participant age, race/ethnicity, biological sex, household income, disease duration, treatment type, and hemoglobin A1c using a HIPAA compliant Internet-based questionnaire.

2.4 |. Procedures

The University of South Florida Institutional Review Board approved this study. Informed consent and adolescent assent were obtained from adolescents and parent or legal guardian after eligibility was established. The qualitative interview was conducted by phone at a time deemed convenient to the adolescent and parent or legal guardian. Participants received a $20 gift card as compensation.

2.5 |. Data management

Interviews were audio-recording using a HIPAA compliant digital recorder. Interviews were transcribed verbatim by a professional transcriptionist and deidentified before analysis. We used ATLAS.ti version 8 (ATLAS.ti Scientific Software Development) to facilitate qualitative data analysis.

2.6 |. Analysis

All interview transcripts were organized with the software program ATLAS.ti version 8. A detailed audit trail was maintained throughout the study. Descriptive statistics regarding participant demographic characteristics and hemoglobin A1c levels were computed using SAS statistical software version 9.2 (SAS Institute, Inc.).

We used the six-phase approach to qualitative data analysis as described by Braun and Clarke (Braun & Clarke, 2006). The analysis was inductive and began during the data collection phase, leading to continuous evolution of the interview guide, and to more focused probes. Sampling continued until data redundancy was agreed upon by all coders (C. G., K. R.). Interviews were coded using an in vivo approach (Saldaña, 2021).

A conceptual coding method was employed by two coders (C. G., K. R.). We developed the final coding structure by synthesizing and collapsing the preliminary in vivo codes through the process of discussion until consensus was achieved. The final coding structure included 35 codes. Using the final codebook, the interviews were then coded again by two coders (C. G., K. R.) concurrently until 80% coding agreement was achieved. Once all interviews were co-coded, we collapsed the codes into categories, and the categories into themes. We underwent a process of member checking, sharing findings with participants to cross-check findings. We also used field notes and detailed memos to refine themes and further bolster reliability of findings.

The criteria for achieving validity in qualitative research as described by Whittemore, Chase, and Mandle (Whittemore et al., 2001) guided our study design and process. We incorporated multiple strategies to maintain methodological trustworthiness, including an audit trail, a two-coder process throughout, and reflective journaling.

3 |. RESULTS

Participants’ demographic characteristics and hemoglobin A1c levels are presented in Table 1. In our sample of 20 adolescents, the mean age was 15 years, 85% identified as non-Hispanic white and 10% identified as Asian, 75% identified as female, 75% utilized insulin pumps, and mean hemoglobin A1c was 7.6%.

The findings for this paper are organized into two themes, with eight subthemes. The two primary themes are (1) the everyday stress of living with T1D and (2) management of stress and psychological well-being. In addition to the quotes below, Table 2 shows representative quotes for each theme and subtheme.

3.1 |. Everyday stress of living with diabetes

Participants frequently described T1D as having a negative impact on their overall psychological state. Participants reported four main types of stress related to their T1D: (1) Increased mental load of management tasks, (2) impact on daily activities, (3) embarrassment and stress of public management, and (4) COVID-19 risk and social isolation.

3.2 |. Increased mental load of management tasks

Participants frequently reported the continuous management of blood sugar levels as the most stressful aspect of having T1D, with one participant describing how it is “always in the back of my mind.” It was common for participants to describe feeling “on edge” that “something can go wrong” at any moment. Frequent calculations and management tasks to balance levels was described as a lot to “keep track of” and plan for, and despite best efforts, participants described feeling “out of control” and frustrated by the “guessing game.”

3.3 |. Impact on daily activities

Daily activities were frequently discussed as a compounding factor to stress of managing T1D. Most often, participation in athletics was brought up as a challenge to balancing blood sugar levels. Participants described worrying how physical activity (e.g., running, swimming, dancing) can impact blood sugar levels, and the necessary, timely management work required to participate (e.g., planning meals, checking blood sugar). They indicated that this additional stress detracts from the enjoyment of participating, as well as confidence.

In addition to participation in sports, stress related to school and sleep were reported. Participants described how it can be difficult to simultaneously manage their blood sugar and focus during class. In addition, participants recalled instances of missing classes or exams; one feeling concerned they would “need to sacrifice either my grade or my health.” Participants also described worrying about “going low” in the night, and how it can negatively impact their own sleep as well as parents.

3.4 |. Embarrassment and stress of public management

Participants frequently described feeling stressed and embarrassed when having to explain their T1D to others who “don’t get it,” including friends, classmates, or strangers (e.g., security at the airport) who have a lack of understanding or misunderstandings. Discomfort at school (even in online classes) was often related to glucose monitor or insulin pump alarms, as others “might not know what the alarm means” and could be mistaken for inappropriate use of a cellular phone. One participant teased by classmates chose to manage their blood sugar in the bathroom to avoid feeling “left out or different.”

3.5 |. COVID-19 risk and social isolation

The COVID-19 pandemic increased stress for participants in many ways. As described by one participant, it was “the emotional stuff that was more of a challenge.” Fear of contracting COVID-19 was quite common, with participants citing how T1D increased personal risk for severe illness. While participants described avoiding contact with others to avoid contracting COVID-19, social isolation increased their anxiety and depression. Participants were particularly affected by the transition from in-person to virtual learning, leaving them feeling disconnected from friends, less physically active, and frustrated by a new learning platform. While some participants mentioned greater ease managing blood sugar levels by staying home (e.g., less work remembering and traveling with management equipment), others described how having “more time to think about diabetes and worry about it” exacerbated their anxiety. Some participants mentioned shipping delays, with one participant unable to access management supplies (e.g., glucose monitor sensors).

3.6 |. Managing stress and supporting psychological well-being

Participants managed stress and psychological well-being through four main ways: (1) support from family, (2) peer support, (3) engagement in activities, and (4) personal acceptance.

3.7 |. Family support with diabetes management, emotional well-being

Most frequently, participants described parents as extremely supportive and involved in management of their T1D and related stress. Parents arrange and attend doctor appointments, purchase, and stock equipment, provide balanced meals and snacks, communicate with teachers, and offer emotional support. One participant expressed gratitude to “have parents with such good insurance…, good money,” and the ability to afford insulin without worry.

It was quite common for parents to be involved with monitoring and managing glucose levels, with some utilizing monitoring apps updated with real-time data. Participants described how parental monitoring can alleviate stress “because I know my parents are able to help me all the time,” particularly when distracted with school, doing activities, or sleeping. For instance, one participant described how their parents can “message me and tell me if I need to give insulin or eat a snack if I’m trending down.” While participants were appreciative of an elevated level of involvement, they also recognized how it can be “annoying” and cause additional stress. It was common for participants to recognize a need for independence and responsibility, as they “can’t be dependent on someone” when attending college or moving away from home.

3.8 |. Peer support from those who “get it”

As described above, peer interactions can be a source of anxiety, with participants commonly stating how they do not want to be treated “differently.” However, participants also described the high value of having support from close friends who understand the impact of T1D and how it must be managed daily. It was common for participants to describe how close friends made them feel at ease and more comfortable with management.

Participants spoke to the benefits of having friends and acquaintances with T1D. Even with effort from close friends to be supportive, participants described how their lack of lived experience limits their ability to do so. Participants described how relationships with others with T1D offered meaningful support from people who “fully understand” and helped them feel “not alone.” Sharing experiences, coping, and information sharing were benefits of relationships with others with T1D.

3.9 |. Engaging in enjoyable, calming activities

In addition to being with family and friends, participants described doing a variety of activities to help manage daily stress. Engaging in physical activity (e.g., sports, walking, yoga, dance) were common techniques to relieve stress, with outdoor activities described as particularly “relieving.” Some participants described methods to distract themselves from stress such as watching a familiar television program, playing video games, using social media, reading, and being with pets. Techniques to calm the mind included taking deep breaths, meditating, and positive affirmations.

3.10 |. Personal acceptance of T1D

Participants commonly described that while initially experiencing elevated levels of stress with adapting to and accepting their diagnosis, this improved over time. Feelings of self-consciousness were particularly difficult during early years following diagnosis, however, participants described T1D is “just part of my life now.” As time passed, participants described feeling more open in discussing T1D with others without fear of judgment, less shame and embarrassment, and higher confidence in management. In addition to acceptance, one participant expressed appreciation for their T1D, commenting they “got it for a reason” and reflected on how it has made them more mature and responsible.

4 |. CONCLUSION

We aimed to explore the daily stressors experienced by adolescents with T1D and how the experience of those stressors impacted their self-management and psychological well-being. We identified two themes and eight subthemes related to the challenges that adolescents face while living with T1D and the common coping strategies that they utilized.

The first theme that emerged from the study was the daily stressors associated with managing T1D. Adolescents reported experiencing a heightened mental burden due to the constant need to monitor their blood glucose levels and perform calculations related to insulin dosage. This was described as mentally exhausting and often left them feeling frustrated and on edge. These findings are consistent with existing literature on the psychological toll of the disease, which extends beyond the physical aspects of management (Hedge et al., 2023). Studies have shown that adolescents with T1D experience a heavy emotional burden, frequent depressive symptoms, and poor sleep, among other psychosocial symptoms (Hagger et al., 2016; Hedge et al., 2023; Jaser et al., 2017). Our findings align with the current body of literature and add the description of “mental exhaustion” and the compounding that occurs with balancing daily disease management with normative activities of daily living.

Adolescents described a recurring source of stress was participation in organized sports. Organized sports and accompanying physical activity play a significant role in the social lives of children and adolescents. While adolescents do reap the benefits of improved mental health, subjective health, reduced risk of cardiovascular disease, and obesity when engaging in physical activity, adolescents with T1D struggle with glycemic excursions that occur as a result of physical activity (Chetty et al., 2019; Logan et al., 2019; Zaharieva et al., 2020). Our findings support the idea that adolescents with and/or parents of adolescents withT1D experience an increased level of stress due to the potential of hypoglycemia during sports and other physical activities (Roberts et al., 2020; Zaharieva et al., 2020). Participants expressed the challenges they faced when needing to calculate insulin levels while simultaneously focusing on a task, such as a sports game. They noted that their diabetes interferes with their ability to fully participate and enjoy this normative activity, often requiring that they stop participation mid-game to manage their disease.

Embarrassment and stress related to the public management of T1D was an important factor in daily self-management behaviors as well as a major contributor to their perception of their primary daily stressors. Adolescents often felt uncomfortable explaining their condition, especially to those who lacked understanding, and performing diabetes care with others present. This is a common finding throughout the existing literature as diabetes-related stigma is persistent and negatively affects quality of life (Brazeau et al., 2018; Eitel et al., 2023). This level of discomfort results in social withdrawal and social awkwardness, as well as avoidance of social situations (Seo, 2021). Participants expressed the fear of being perceived differently and having to manage their condition “in secret”; this helps to explain why acute diabetes complications are associated with higher levels of diabetes stigma in adolescents (Brazeau et al., 2018; Eitel et al., 2023).

The COVID-19 pandemic added another layer of stress to the lives of these adolescents. Most participants feared they would be severely affected by COVID-19. Studies have shown that high-risk groups including individuals with T1D are at risk for severe infection, hospitalization, increased mortality rates, and anxiety (Caballero et al., 2020; Karavanaki et al., 2023; Wade et al., 2022). The fear of COVID-19 added to the experience of daily stress and the feeling of social isolation. Participants expressed fear of lack of access to medical supplies and an increased risk of severe infection.

While daily stress was a common theme among our sample, adolescents also expressed the importance of stress management techniques and social support related to their experience of heightened stress. Adolescents with T1D rely on a strong social support network to manage their stress and mitigate the experience of social isolation (Chetty et al., 2019; Jaser et al., 2017). They emphasized the stress associated with managing T1D through school, in public settings, and at home was easier to manage when they felt understood and supported by their peers. They also described the importance of family support in diabetes management, indicating that reliable parents/guardians served as a “back-up” or safety net when the mental load of managing diabetes and daily life became overwhelming.

4.1 |. Strengths and limitations

We used a qualitative descriptive approach, allowing an in-depth exploration of the experiences of living with the daily burden of T1D. This approach provides comprehensive details about the most common daily stressors adolescents faced and the coping strategies they employed. We used several strategies to ensure methodological trustworthiness, including two experienced coders, reflective journaling, and a detailed audit trail. In addition, the sample included adolescents of varied ages, biological sex, and treatment modalities, which increased the generalizability of the study.

There are several limitations to consider. The data were collected during the COVID-19 pandemic, which introduced unique stressors that do not apply to non-pandemic times. Additionally, participants were recruited through online ads, which may not capture experiences of adolescents who don’t have access to or are not active on social media. This sample identified as 85% non-Hispanic, white, and further studies are required to explore the experiences of adolescents in diverse racial/ethnic groups.

4.2 |. Implications for further research

Future research can explore innovative technologies and strategies to improve glycemic control during physical activity and enhance educational support and emotional and social support from peers and family. This in-depth understanding of the daily lives of adolescents with T1D will help to foster strategies to improve the transition to independence when reaching adulthood.

The importance of social support emerged as a key subtheme in this study. The dynamics of peer support networks among adolescents with T1D is an important area to expand upon. Support network formation, sustainability, and impact on the psychological well-being of adolescents with T1D could be further explored. Addressing this can provide a foundation for interventions that create and harness the power of peer support. Based on this study, future interventions could focus on addressing strategies that manage the mental load of daily management tasks, coping mechanisms for dealing with public management, and support systems during future hardships such as, the COVID-19 pandemic. The development of future interventions such as physical exercise, relaxation techniques, and stress reducing techniques can be beneficial to those participants that need guidance managing stress.

4.3 |. How might this information affect nursing practice?

Understanding the unique daily stressors faced by adolescents with T1D, such as the constant mental burden of T1D management and its impact on their daily activities, informs nursing interventions aimed at holistic patient care. Nurses play a pivotal role in reinforcing the importance of healthy coping mechanisms, such as family and peer support networks, engagement in stimulating physical or mindful activities, and personal acceptance. Additionally, the study highlights the unique challenges introduced during the COVID-19 pandemic, emphasizing a need for tailored nursing strategies during times of crisis. Integrating this information into nursing education and practice can enhance sensitivity to the psychosocial aspects of T1D, promoting a comprehensive, patient-centered, and empathetic approach to care. Moreover, specific stressors, like those related to public T1D management, impact on daily activities, and mental burden, allows nurses to proactively address sources of discomfort and/or embarrassment, which support positive patient outcomes and the overall well-being of adolescents with T1D.

What is currently known?

Type 1 diabetes (T1D) is a chronic medical condition that requires an intensive and complex daily treatment regimen. Adolescents with T1D frequently experience heightened stress and anxiety as a result of living with a demanding, life-threatening chronic condition. Evidence-based interventions that address stress in a cost-effective and accessible way are needed.

What does this article add?

The findings highlight the significant mental load of constant daily disease management and impact on normative daily activities. Participants emphasized the importance of family and peer support in mitigating stress and enhancing psychological well-being. This adds a comprehensive basis from which to refine existing nursing interventions and to design tailored to this population.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.