The 600-step program for type 1 diabetes self-management in youth: the magnitude of the self-management task.

This article demonstrates the complexity of the type 1 diabetes regimen and describes the physician's role in safely promoting self-management of diabetes by youth. Literature describing type 1 diabetes and the required regimen, issues related to regimen adherence by youth, demonstration of the magnitude of the regimen, and implications for physicians are addressed. A task analysis and tool for physicians is presented that contains over 600 tasks. Given the magnitude of the regimen, issues related to the physician's promotion of the gradual transfer of regimen control to youth are illustrated. The importance of understanding broad areas of the regimen (eg, "insulin injection") as not one task but many is emphasized, as is the need to explore adherence within regimen areas to pinpoint problems related to poor metabolic control. The article also examines how managed care influences the approach that a physician may take to communicate the requirements of the complex regimen to youth and parents. It is concluded that a developmentally sensitive approach must be taken that promotes youths' internalization of the importance of regimen tasks, and suggestions are provided for accomplishing this in a gradual manner that promotes developmentally appropriate involvement of youth in the regimen without premature responsibility.