Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model

Abstract

The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N = 226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9–11 years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1 year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1 year later (p < 0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.

The reliability and validity of the revised Diabetes Family Conflict Scale questionnaire, in a sample of Swedish children

“…This relationship was true for child‐, mother‐ and father reports. These findings are consistent with previous research and thus add to the accumulated knowledge on the relationship between family conflict and the child's metabolic control . Further analysis revealed a correlation between the direct management subscale and glycemic control for both child‐ and caregiver reports that was marginally stronger than the correlation between the total scale and glycemic control, whereas the subscale indirect management only showed a weak correlation at the 0.05 level for the father report.…”

Identification and prediction of group-based glycemic control trajectories during the transition to adolescence.

“…Data were collected as part of an ongoing, three-year longitudinal study. Reports of longitudinal data from this study have been previously described in Drotar et al (2013), Rausch et al (2012), and Rohan et al (2013). This is the first report from this study that has focused on identification of trajectories of glycemic control across time and the prediction of glycemic control group membership over three years.…”

“…Relatively little is known about the specific distribution of trajectories of glycemic control among early adolescents with type 1 diabetes and the factors that predict them. Most studies have focused on description and prediction of average levels of glycemic control, often over limited periods (e.g., one year) (Butler et al, 2008; Drotar et al, 2013; Helgeson & Palladino, 2012; Ingerski, Anderson, Dolan, & Hood, 2010). …”

Type 1 Diabetes in Children and Adolescents

“…A careful multidisciplinary assessment should be undertaken for every child with chronically poor metabolic control (e.g. A1C >10%) to identify potential causative and associated factors, such as depression (54), eating disorders (55), lower socioeconomic status, lower family support and higher family conflict (56,57), and to identify and address barriers to improved glycemic control. Use of a standardized measure of risk factors has been shown to identify those at high risk for poor control, emergency room visits and DKA (58).…”