Associations between major life events and adherence, glycemic control, and psychosocial characteristics in teens with type 1 diabetes

Abstract

Aims: This cross-sectional study assessed the type of major life events occurring in a contemporary sample of teens with type 1 diabetes and the association between event frequency and demographic, diabetes management, and psychosocial characteristics.Methods: Parents of 178 teens completed the Life Events Checklist to report major events teens had experienced in the last year: 42% experienced 0 to 1 event (n = 75), 32% experienced 2 to 3 events (n = 57), and 26% experienced 4+ events (n = 46). Teens and parents completed validated measures of treatment adherence, diabetes-specific self-efficacy, quality of life, and diabetes-specific family conflict. Parent-youth interview and chart review provided demographics and diabetes management data.Results: Mean number of events/teen was 2.6 AE 2.7 (range = 0-15). The most common events were "Hospitalization of a family member" (24%), "Getting a bad report card" (20%), "Serious arguments between parents" (19%), and "Serious illness/injury in a family member" (19%). Compared with teens experiencing 0 to 1 event, teens experiencing 4+ events were less likely to have married parents (P = .01) and a parent with a college degree (P = .006). Teens with 4+ events had significantly poorer adherence (P = .002 teen, P = .02 parent), lower self-efficacy (P = .03 teen, P < .0001 parent), poorer quality of life (P < .0001 teen, P < .0001 parent), and more conflict (P = .006 teen, P = .02 parent) than teens with fewer events. In a multivariate model (R 2 = 0.21, P < .0001) controlling for demographic and diabetes management characteristics, fewer events was associated with lower A1c (P = .0009).Conclusions: Occurrence of more major life events was associated with poorer diabetes careand A1c and more negative psychosocial qualities in teens with type 1 diabetes.

Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes

“…We found that HbA1c was significantly increased among children who experienced three or more adverse events (9.66% (12.8 mmol/mol) versus 8.19% (66.0 mmol/mol); β: 0.63 (4.5 mmol/mol); 95% CI: 0.11-1.15 (1.08-10.2 mmol/mol); p = 0.02). Similarly, Commissariat et al showed that among 178 teens with T1DM, glycated hemoglobin was higher in those who experienced more stressful life events [17]. We also found that the HbA1c was 0.62% (4.4 mmol/mol) higher in children who lived with a household member who had served time in jail, and 0.71% (5.4 mmol/mol) higher in those who had witnessed or had been a victim of violence in the neighborhood, when compared to those who did not have such exposure.…”

The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study

“…As a result, adolescents may avoid taking responsibilities of self-management of diabetes and lead to unsuccessful glycemic control. Commissariat et al’s [ 10 ] study confirmed that increased conflicts between parents and adolescents may lead to poorer adherence and lower self-efficacy.…”

“…Literature has shown that better self-management in adolescents increased the likelihood of achieving good glycemic control [ 7 , 8 , 9 ]. However, studies also revealed that many adolescents with T1D did not achieve good glycemic control [ 10 , 11 , 12 ]. It is critical for healthcare providers to gain an in-depth insight into the experience of adolescents with T1D self-management of blood glucose.…”

“…Negative emotional distress, such as anxiety and depression [ 15 , 16 , 17 ] and low self-esteem [ 18 , 19 ], decreased actions of adolescents with T1D in managing diabetes. The adolescents’ conflicts with parents [ 10 , 20 ], stress from school, and peer perceptions toward diabetes care also impacted effectiveness of self-management of diabetes [ 21 ]. Moreover, the self-efficacy of adolescents with T1D is critical for effective self-management of diabetes Studies also discovered that adolescents with T1D with higher self-efficacy had better self-management of diabetes [ 11 , 14 ].…”

Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers

“…Other issues that might be important to screen for include stressful life events, as youth with more stressors have poorer quality of life, treatment adherence, and glycemic outcomes. 43 After deciding on the constructs to measure in a screening protocol, an important consideration is the selection of instruments to use. Sequential screening is one option to integrate both features: individuals who screen high on a highly sensitive measure then complete a second screener with high specificity, and those who score high on both receive further evaluation by a clinician.…”