Family factors, particularly dynamic and communication factors such as parental over-involvement and adolescent-parent concordance on responsibility for diabetes care appear be important determinants of metabolic outcomes in adolescents with diabetes. However, family dynamic factors do not account for the substantial differences in metabolic outcomes between centres.

Background:  The Hvidoere Study Group on Childhood Diabetes has demonstrated persistent differences in metabolic outcomes between pediatric diabetes centers. These differences cannot be accounted for by differences in demographic, medical, or treatment variables. Therefore, we sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers. Methods:  An observational cross‐sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants. Hemoglobin A1c (HbA1c) levels were assayed in one central laboratory. All individuals with diabetes aged 11–18 yr (49.4% female), with duration of diabetes of at least 1 yr, were invited to participate. Individuals completed a self‐reported measure of quality of life (Diabetes Quality of Life ‐ Short Form [DQOL‐SF]), with well‐being and leisure time activity assessed using measures developed by Health Behaviour in School Children WHO Project. Results:  Older participants (p < 0.001) and females (p < 0.001) reported less physical activity. Physical activity was associated with positive health perception (p < 0.001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis. The more time spent on the computer (r = 0.06; p < 0.05) and less time spent doing school homework (r = −0.09; p < 0.001) were associated with higher HbA1c. Between centers, there were significant differences in reported physical activity (p < 0.001) and sedentary behavior (p < 0.001), but these differences did not account for center differences in metabolic control. Conclusions:  Physical activity is strongly associated with psychological well‐being but has weak associations with metabolic control. Leisure time activity is associated with individual differences in HbA1c but not with intercenter differences.

Objective: Women of lower educational attainment have less balanced and varied diets than women of higher educational attainment. The diets of women are vital to the long-term health of their offspring. The present study aimed to identify factors that influence the food choices of women with lower educational attainment and how women could be helped to improve those choices. Design: We conducted eight focus group discussions with women of lower educational attainment to identify these factors. We contrasted the results of these discussions with those from three focus group discussions with women of higher educational attainment. Setting: Southampton, UK. Subjects: Forty-two white Caucasian women of lower educational attainment and fourteen of higher educational attainment aged 18 to 44 years. Results: The dominant theme in discussions with women of lower educational attainment was their sense that they lacked control over food choices for themselves and their families. Partners and children exerted a high degree of control over which foods were bought and prepared. Women's perceptions of the cost of healthy food, the need to avoid waste, being trapped at home surrounded by opportunities to snack, and having limited skill and experience with food, all contributed to their sense they lacked control over their own and their family's food choices. Conclusions: An intervention to improve the food choices of women with lower educational attainment needs to increase their sense of control over their diet and the foods they buy. This might include increasing their skills in food preparation. Keywords Food choice Health benefits Education Focus groups UKStudies from across Europe have identified a relationship between educational attainment and diet. Education level was the most important social variable in explaining differences in vegetable and fat intake in a random sample of Danish men and women (1) , and having no qualifications was a significant predictor of low healthy eating scores in 7434 men and women in the Scottish Health Survey (2) . In a group of 6125 women who took part in the Southampton Women's Survey, it was found that women who leave school with few or no qualifications eat a less balanced or 'prudent' diet than women with qualifications (3) . A 'prudent' diet in this survey was characterised by high intakes of fruit and vegetables, wholemeal bread, rice, pasta, yoghurt and breakfast cereals. An 'imprudent' diet was characterised by high intakes of chips and roast potatoes, sugar, white bread, red and processed meats, full-fat dairy products, crisps, sweets, tinned vegetables, cakes and biscuits. More than half of the women who left school with no qualifications were in the lowest quarter of the 'prudent' diet score. This proportion fell progressively with increasing qualifications, so that only 3 % of women with university degrees had scores in the lowest quarter. This relationship was not explained by social class. Women's diets are important not only for their own health but also for that of...

The increased prevalence of depressive symptoms in diabetes is not manifest until at least 1 year post diagnosis in this cohort. However, there are a significant number of people with persistent depressive symptoms in the early stages of diabetes, and diabetes-specific distress may be contributing to subsequent development of depressive symptoms in people with Type 2 diabetes.

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