Glycemic control and type 1 diabetes: the differential impact of model of care and income

Hatherly, Kristy; Smith, Lorraine; Overland, Jane; Johnston, Christine; Brown-Singh, Lin; Waller, Daniel; Taylor, Susan

doi:10.1111/j.1399-5448.2010.00670.x

Cited by 28 publications

(23 citation statements)

References 15 publications

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“…This finding is consistent with previous studies which have demonstrated that low-income is a risk factor for poorer outcomes in adolescents with T1D and that adolescents from low-income families report greater general stress levels than their peers from higher income families [14,22,32]. We also found that adolescents from racially diverse backgrounds reported both higher general stress and diabetes-specific stress than their Caucasian peers.…”

Section: Discussionsupporting

confidence: 93%

General and diabetes-specific stress in adolescents with type 1 diabetes

Rechenberg

Whittemore

Holland

et al. 2017

Diabetes Research and Clinical Practice

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Background Type 1 diabetes (T1D) is one of the most common chronic health conditions in adolescents in the United States. Adherence to the recommended treatment regimen has been reported as a source of stress for adolescents. Aim The purpose of this study was to examine the associations among general and diabetes-specific stress and glycemic control (HbA1c), self-management, and diabetes-specific quality of life (QOL) in adolescents with T1D. Methods A secondary analysis of baseline data (N = 320) from a randomized controlled trial was conducted. Adolescents completed validated measures of general and diabetes-specific stress, self-management, and diabetes-specific QOL. HbA1c levels were obtained from medical records. Results Over 50% of the sample scored at or above criteria for high general and diabetes-specific stress. Higher general and diabetes-specific stress was significantly associated with higher HbA1c, poorer self-management activities, and lower diabetes-specific QOL. Diabetes-specific stress accounted for a significant proportion of the variance in HbA1c, while general stress did not. General and diabetes-specific stress accounted for 40% of the variance in diabetes-specific QOL. Conclusions General and diabetes-specific stress are common in adolescents with T1D. Healthcare providers must be mindful of the sources of stress that adolescents with T1D face on a daily basis. General stress and diabetes-specific stress should be differentiated and may require different interventions to improve coping and outcomes.

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Section: Discussionsupporting

confidence: 93%

General and diabetes-specific stress in adolescents with type 1 diabetes

Rechenberg

Whittemore

Holland

et al. 2017

Diabetes Research and Clinical Practice

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“…A total of 158 children and adolescents, 8–19 years of age, together with their families, were recruited into the DRAT study, independent of their source of care. As described elsewhere (1,2), the DRAT study involved three annual visits for which a researcher traveled to interview the young person and their family in their home. At each of these annual visits, participants completed a series of validated questionnaires and underwent a structured interview.…”

Section: Methodsmentioning

confidence: 99%

“…In Australia, and many other countries, a large proportion of young people with diabetes are not reaching glycemic targets (1–6). This is likely to have life-long consequences.…”

mentioning

confidence: 99%

Glycemic Control and Blood Glucose Monitoring Over Time in a Sample of Young Australians With Type 1 Diabetes

et al. 2013

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OBJECTIVETo determine whether personality traits (conscientiousness, agreeableness, emotional regulation, extraversion, and openness to experience) are associated with glycemic control and blood glucose monitoring behavior, and change or stability of these outcomes over time, in young people with type 1 diabetes.RESEARCH DESIGN AND METHODSA 3-year longitudinal study was conducted using data from 142 individuals with type 1 diabetes, 8–19 years of age. Personality was assessed at baseline using the Five-Factor Personality Inventory for Children. Data relating to glycemic control (HbA1c) and frequency of blood glucose monitoring (based on meter memory) were collected annually. Relationships between personality traits and HbA1c and monitoring frequency were examined using regression models and mixed-design ANOVA.RESULTSThree of the Five-Factor domains were independently associated with glycemic control. Individuals high in conscientiousness and agreeableness had a lower and more stable HbA1c across the 3-year study period. In contrast, the HbA1c of individuals scoring low on these traits was either consistently worse or deteriorated over time. Low or high emotional regulation scores were also associated with worse glycemic control. By the third year, these domains, together with initial HbA1c, accounted for 39% of HbA1c variance. Conscientiousness was the only personality factor associated with blood glucose monitoring behavior.CONCLUSIONSResults of this study underline the importance of personality in contributing to diabetes outcomes. Attention to a young person’s personality, and appropriate tailoring of diabetes management to ensure an individualized approach, may help to optimize diabetes outcomes.

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“…Given the complexity of treating T1D and T2D, particularly in youth, patients often seek care from a specialist. 38 In our sample, the type of care was strongly dependent on diabetes type, with 71% of YYA with T1D treated by a specialist vs 16% by a primary care provider, compared to YYA with T2D of whom 32% were seen by a specialist and 26% a primary care provider. Given that pediatric and adult endocrinologists are predominantly located in urban areas in the US, whereas primary care is more widely distributed, it has been suggested that complex care delivery for persons with diabetes may be improved by having primary care providers in rural areas partner with specialists using telehealth.…”

Section: Discussionmentioning

confidence: 72%

“…We did not find evidence for a significant difference in glycemic control between those receiving care by a primary care provider compared to a specialist. Given the complexity of treating T1D and T2D, particularly in youth, patients often seek care from a specialist . In our sample, the type of care was strongly dependent on diabetes type, with 71% of YYA with T1D treated by a specialist vs 16% by a primary care provider, compared to YYA with T2D of whom 32% were seen by a specialist and 26% a primary care provider.…”

Section: Discussionmentioning

confidence: 99%

Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina

Liese

Reid

et al. 2019

Pediatr Diabetes

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Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA1c values. In multivariate models, YYA with state or federal health insurance had HbA1c percentage values 0.68 higher (P = 0.0025) than the privately insured, and those without insurance 1.34 higher (P < 0.0001). Not having a routine diabetes care provider was associated with a 0.51 higher HbA1c (P = 0.048) compared to having specialist care, but HbA1c did not differ significantly (P = 0.069) between primary vs specialty care. Distance to utilized provider was not associated with HbA1c among YYA with a provider (P = 0.11). These findings underscore the central role of health insurance and indicate a need to better understand the root causes of poorer glycemic control in YYA with state/federal insurance.

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Glycemic control and type 1 diabetes: the differential impact of model of care and income

Cited by 28 publications

References 15 publications

General and diabetes-specific stress in adolescents with type 1 diabetes

General and diabetes-specific stress in adolescents with type 1 diabetes

Glycemic Control and Blood Glucose Monitoring Over Time in a Sample of Young Australians With Type 1 Diabetes

Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina

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