Risk for metabolic control problems in minority youth with diabetes.

Delamater, Alan M.; Shaw, Kimberly H.; Applegate, E. Brooks; Pratt, Indira Abraham; Eidson, Margaret; Lancelotta, G X; Gonzalez-Mendoza, Luis; Richton, Samuel

doi:10.2337/diacare.22.5.700

Cited by 194 publications

(120 citation statements)

References 4 publications

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“…Previous intervention research was conducted with primarily white, middle-class samples and therefore did not address the needs of minority and/or low-income adolescents with diabetes. This is an important gap in the literature, because minority subjects are more likely to suffer from CPMC 36,37 and minority adolescents with chronic illnesses have increased rates of stress, compared with nonminority subjects. 38 Gender was not addressed in previous intervention studies, although adolescent female subjects with diabetes tend to report higher levels of diabetes-related stress than do adolescent male subjects.…”

Section: Effects Of Multisystemic Therapy On Diabetes Stressmentioning

confidence: 79%

The Effects of Multisystemic Therapy on Diabetes Stress Among Adolescents With Chronically Poorly Controlled Type 1 Diabetes: Findings From a Randomized, Controlled Trial

Ellis¹,

Frey²,

Naar‐King³

et al. 2005

Pediatrics

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ABSTRACT. Objective. The goal of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes. Stress was also evaluated as a mediator of the effect of MST on adherence and metabolic control.Methods. A randomized, controlled trial was conducted with 127 adolescents with type 1 diabetes mellitus and chronically poor metabolic control (hemoglobin A1c levels of >8% at study enrollment and for the past 1 year) who received their diabetes care in a children's hospital located in a major Midwestern city. Participants assigned randomly to MST received treatment for ϳ6 months. Data were collected at baseline and at a 7-month posttest (ie, treatment termination). Changes in diabetes-related stress, as measured with a self-report questionnaire, were assessed. Structural equation models were used to test the degree to which changes in stress levels mediated the ability of the MST intervention to improve adherence and metabolic control.Results. In intent-to-treat analyses, participation in MST was associated with significant reductions in diabetes-related stress. Tests for moderation found no significant effects of age, gender, or ethnicity, which suggests that the intervention was equally effective in reducing diabetes stress for all participants. However, structural equation modeling did not provide support for diabetes stress as the mechanism through which MST improved health outcomes. Rather, the final model suggested that MST improved metabolic control through increased regimen adherence.Conclusions. Intensive, home-based psychotherapy reduces diabetes-related stress among adolescents with chronically poorly controlled type 1 diabetes. Such stress reductions are important for the psychological wellbeing of a subset of youths with diabetes who are at high risk for future health complications. A dolescents with type 1 diabetes mellitus face a number of stressors and challenges as a result of their chronic illness. [1][2][3][4] These include the need to manage a complex medical condition that requires daily completion of multiple selfcare behaviors, the impact of diabetes on social interactions with family members, peers, and teachers, and the interference of symptoms such as hypoglycemia with daily activities.Previous studies investigated the impact of stress on health outcomes among persons with type 1 diabetes. The effects of stress on regimen adherence and metabolic control have been of particular interest. Stress has the potential to affect metabolic control directly through its impact on cortisol and other catabolic hormones that interfere with insulin metabolism. It may also affect metabolic control indirectly, by interfering with completion of self-care tasks. However, prior findings have been mixed, with some studies supporting a direct relationship between stress and metabolic control, some suggesting that adherence mediates the relationship between stress and me...

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Section: Effects Of Multisystemic Therapy On Diabetes Stressmentioning

confidence: 79%

The Effects of Multisystemic Therapy on Diabetes Stress Among Adolescents With Chronically Poorly Controlled Type 1 Diabetes: Findings From a Randomized, Controlled Trial

Ellis¹,

Frey²,

Naar‐King³

et al. 2005

Pediatrics

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“…Racial disparities exist in the treatment and outcomes of children with type 1 diabetes. It has been shown that black children with type 1 diabetes have poorer metabolic control (21)(22)(23)(24). A ninefold increased risk of death was demonstrated for young African Americans with diabetes in Chicago, compared with non-Hispanic white patients with type 1 diabetes over an 8-year period (25).…”

Section: Conclusion -In 1990mentioning

confidence: 99%

Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999

et al. 2006

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OBJECTIVE—To determine the epidemiology of type 1 diabetes in children in Philadelphia, Pennsylvania, from 1995 through 1999 and compare these data with previous cohorts. RESEARCH DESIGN AND METHODS—This is a report of a retrospective population-based registry maintained since 1985. Hospital records meeting the following criteria were reviewed: newly diagnosed type 1 diabetes, age 0–14 years, residing in Philadelphia at the time of diagnosis, and diagnosed from 1 January 1995 to 31 December 1999. The secondary source of validation was the School District of Philadelphia. Incidence rates by race and age were compared with 1985–1989 and 1990–1994 cohorts. RESULTS—A total of 234 case subjects were identified, and the registry was determined to be 96% complete. The overall age-adjusted incidence rate in Philadelphia was 14.8 per 100,000/year. Incidence rates in Hispanic children (15.5 per 100,000/year) and white children (12.8 per 100,000/year) have been relatively stable over 15 years. The incidence in black children (15.2 per 100,000/year), however, has increased dramatically, rising 64% in children 5–9 years of age (14.9 per 100,000/year) and 37% in the 10- to 14-year age-group (26.9 per 100,000/year). CONCLUSIONS—The overall incidence of type 1 diabetes in Philadelphia is increasing and is similar to other U.S. registries. These are the first data reporting a higher incidence in black children in a registry of children 0–14 years of age. The etiology of the marked increase in incidence in the black population is unknown and underscores the need to establish type 1 diabetes as a reportable disease, so that environmental risk factors may be thoroughly investigated.

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“…Although data in childhood are limited, poor metabolic control tracks through adolescence and, in turn, HbA 1c in adolescence is strongly correlated with later adult diabetes-related outcome [10][11][12]. Cross-sectional studies typically show that children of ethnic minorities have higher HbA 1c levels [13][14][15][16]. However, it remains unclear whether this poorer metabolic control is independent of SES, and many of the studies examined selected cohorts that may not be representative of the general population [2,[17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

et al. 2008

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Aims/hypothesis This study was performed to evaluate the influence of ethnicity and socioeconomic status (SES) on metabolic control in a population-based cohort of children with type 1 diabetes mellitus, and to evaluate whether any relationship between ethnicity and HbA 1c is mediated by SES. Methods We performed a retrospective review of all patients under age 16 years with type 1 diabetes (n=555) from 1995 to 2005 in the greater Auckland region, New Zealand. Diabetes care variables and HbA 1c values were collected prospectively, during clinic visits. Results The mean population HbA 1c was 8.3±1.3%. Maori and Pacific patients had poorer metabolic control than their European counterparts (9.1% and 9.3% vs 8.1%, p<0.001) and higher rates of moderate to severe hypoglycaemia (31.1 and 24.8 vs 14.9 events/100 patient-years, p=0.03). In multiple linear regression analysis, both ethnicity and SES were independently associated with HbA 1c (p<0.001). Other factors associated with higher HbA 1c level were longer duration of diabetes, higher insulin dose, lower BMI z score and less frequent blood glucose monitoring (p<0.001).Conclusions/interpretation Both ethnicity and SES independently influenced metabolic control in a large, unselected population of children with type 1 diabetes. Irrespective of SES, Maori and Pacific youth with type 1 diabetes were at greater risk of both moderate to severe hypoglycaemia and long-term complications associated with poor metabolic control.

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Risk for metabolic control problems in minority youth with diabetes.

Cited by 194 publications

References 4 publications

The Effects of Multisystemic Therapy on Diabetes Stress Among Adolescents With Chronically Poorly Controlled Type 1 Diabetes: Findings From a Randomized, Controlled Trial

The Effects of Multisystemic Therapy on Diabetes Stress Among Adolescents With Chronically Poorly Controlled Type 1 Diabetes: Findings From a Randomized, Controlled Trial

Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

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