Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model (original) (raw)
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Family conflict, adherence, and glycaemic control in youth with short duration Type 1 diabetes
Diabetic Medicine, 2002
Aims Behavioural support around diabetes management tasks is linked to glycaemic outcomes. In this study we investigated the relationship between diabetes-related parental behaviours (conflict around and involvement in treatment tasks), adherence to blood glucose monitoring (BGM), and glycaemic control in youth with short duration Type 1 diabetes mellitus (DM).
Pediatric diabetes, 2015
The current study examined how a comprehensive set of variables from multiple domains, including at the adolescent and family level, were predictive of glycemic control in adolescents with type 1 diabetes (T1D). Participants included 100 adolescents with T1D ages 10-16 yrs and their parents. Participants were enrolled in a longitudinal study about youth decision-making involvement in chronic illness management of which the baseline data were available for analysis. Bivariate associations with glycemic control (HbA1C) were tested. Hierarchical linear regression was implemented to inform the predictive model. In bivariate analyses, race, family structure, household income, insulin regimen, adolescent-reported adherence to diabetes self-management, cognitive development, adolescent responsibility for T1D management, and parent behavior during the illness management discussion were associated with HbA1c. In the multivariate model, the only significant predictors of HbA1c were race and i...
Journal of Behavioral Medicine, 2011
To examine whether individual psychological variables mediate the family conflict-glycemic control relationship. During three study visits spanning 9 months, 147 adolescents with type 1 diabetes completed questionnaires measuring anxiety and depressive symptoms, and diabetes-specific worry. Caregivers similarly completed a measure of diabetes-specific family conflict. Blood glucose monitoring frequency and glycemic control were also obtained during study visits. Separate mediation analyses revealed that anxiety was the only individual psychological variable that mediated the caregiver-reported family conflict-glycemic control link. Anxiety accounted for 20% of the family conflict-glycemic control link, compared to 8.5% for depression and 6% for diabetes-specific worry. Results suggest that anxiety symptoms may be promoted in a family environment characterized by conflict and these symptoms have detrimental effects on glycemic control. Continued monitoring of family functioning and adolescents' anxiety symptoms, as well as refinement of interventions, is needed to promote positive health outcomes.
Diabetes Care, 2009
OBJECTIVE To determine developmental classes of glycemic control in young people with type 1 diabetes throughout adolescence and emerging adulthood and assess relationships with general family climate and self-concept. RESEARCH DESIGN AND METHODS In an eight-wave longitudinal study, 72 individuals (37 females) completed questionnaires assessing family climate (at times 1–4) and self-concept (at times 1–4 and 6). Times 1–4 covered adolescence (mean ages were 14–17 years, respectively); times 5–8 covered emerging adulthood (mean ages were 21–25 years, respectively). At each time point, patients visited their physicians to determine A1C values, and questionnaires were sent to the physicians to obtain these values. Latent class growth analysis was used to identify developmental classes of glycemic control. RESULTS Latent class growth analysis favored a three-class solution, consisting of optimal control (n = 10), moderate control (n = 51), and deteriorating control (n = 11). From time 3...
Glycemic Control in Youth with Type 1 Diabetes: Family Predictors and Mediators
Journal of Pediatric Psychology, 2008
Objective This study examined predictive and mediated relationships among youth perception of critical parenting, Child Behavior Checklist Externalizing Subscale (CBCL) externalizing problem scores, adherence, and (hemoglobin A 1c HbA 1c ), in youth with type 1 diabetes from low socioeconomic status families. Methods Caregiver/youth dyads (n ¼ 120) completed diabetes specific measures of family functioning regarding diabetes management and structured adherence interviews. Parents completed the CBCL, while assays of youth HbA 1c were performed. Analyses were conducted using hierarchical linear regression. Results Combined measures predicted 44% of the variance in HbA 1c . Adherence partially mediated critical parenting and HbA 1c , while critical parenting and adherence mediated CBCL externalizing problem scores and HbA 1c . CBCL externalizing problem scores did not mediate critical parenting and HbA1 c . Conclusions The presence of youth perceptions of critical parenting and youth externalizing behavior problems may interfere with adherence, leading to increases in HbA 1c .
Family characteristics of diabetic adolescents: relationship to metabolic control
Diabetes Care, 1981
This research compares the family environments of diabetic adolescents in good (HbA lc < 10), fair (10 ^ HbA lc ^ 14), and poor (HbA lc > 14) control. Fifty-eight adolescents diagnosed with type I diabetes and their parents (mothers) were independently assessed with structured interviews, the Moos Family Environment Scale, and adolescents also completed the Piers-Harris Children's Self-Concept Scale. As compared with adolescents in poor control, those in good control reported fewer diabetes-related symptoms and had less anxiety and a more positive self-concept. Well-controlled youths also reported more cohesion and less conflict among family members. More parents of well-controlled youths stated that family members were encouraged to behave independently. In addition, more parents of poorly controlled adolescents believed that diabetes had negatively affected the child's personality, physical well-being, schooling, and participation in activities away from home. These findings suggest a complex interplay between the diabetic adolescent's psychological and physical functioning, metabolic control, and the family environment,
Journal of Diabetes Research
Objective. To evaluate (1) the longitudinal relationship between parental well-being and glycemic control in youth with type 1 diabetes and (2) if youth’s problem behavior, diabetes parenting behavior, and parental diabetes-distress influence this relationship. Research Design and Methods. Parents of youth 8–15 yrs (at baseline) (N=174) participating in the DINO study completed questionnaires at three time waves (1 yr interval). Using generalized estimating equations, the relationship between parental well-being (WHO-5) and youth’s HbA1c was examined. Second, relationships between WHO-5, Strength and Difficulties Questionnaire (SDQ), Diabetes Family Behavior Checklist (DFBC), Problem Areas In Diabetes-Parent Revised (PAID-Pr) scores, and HbA1c were analyzed. Results. Low well-being was reported by 32% of parents. No relationship was found between parents’ WHO-5 scores and youth’s HbA1c (β=−0.052, p=0.650). WHO-5 related to SDQ (β=−0.219, p<0.01), DFBC unsupportive scale (β=−0.174...
Journal of pediatric psychology, 2015
Youth with Type 1 diabetes (T1D) from single-parent families have poorer glycemic control; a finding confounded with socioeconomic status (SES). Family density (FD), or youth:adult ratio, may better characterize family risk status. METHODS: Structural equation modeling assessed the relation of single-parent status, SES, and FD to parenting stress, diabetes-related conflict, parental monitoring, adherence, and glycemic control using cross-sectional parent and youth data (n = 257). RESULTS: Single-parent status exhibited similar relations as SES and was removed. Lower FD was associated with better glycemic control (β = -.29, p = .014) via less conflict (β = .17, p = .038) and greater adherence (β = -.54, p < .001). CONCLUSIONS: Beyond SES, FD plays a significant role in adherence and glycemic control via diabetes-related conflict. In contrast, the effects of single-parent status were indistinguishable from those of SES. FD provides distinct information related to adolescent ...
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2017
Type 1 diabetes management involves self- and social-regulation, with past research examining components through individual differences unable to capture daily processes. Dynamical systems modeling was used to examine the coordinative structure of self- and social-regulation (operationalized as parental-regulation) related to daily diabetes management during late adolescence. Two hundred and thirty-six late adolescents with type 1 diabetes (M age = 17.77 years, SD = .39) completed a 14-day diary reporting aspects of self- (e.g., adherence behaviors, cognitive self-regulation failures, and positive and negative affect) and parental-regulation (disclosure to parents, knowledge parents have, and help parents provide). Self-regulation functioned as one coordinative structure that was separate from parental-regulation, where mothers and fathers were coordinated separately from each other. Mothers' perceived helpfulness served as a driver of returning adolescents back to homeostasis. ...