The impact of physiological, therapeutic and psychosocial variables on glycemic control in youth with type 1 diabetes mellitus.
OBJECTIVE
Intensive management of type 1 diabetes mellitus (DM1) in youth is challenging. We evaluated the relative impact of variables related to DM1 among groups of pre/early pubertal, midpubertal and postpubertal youths with DM1.


METHODS
In this cross-sectional study of 153 youth with DM1, we ascertained Tanner stage, insulin dose and delivery modality (CSII vs MDI), daily blood glucose monitoring (BGM) frequency, and most recent hemoglobin A1c (HbA1c). We collected questionnaires from patients and their parents on diabetes-specific family conflict and family involvement in diabetes management tasks. We assessed predictors of glycemic control according to pubertal status.


RESULTS
Insulin doses increased between pre/ early puberty and midpuberty (p <0.0001); daily BGM frequency (p = 0.02) and family involvement for DM management (p <0.001) were lowest in the postpubertal group. HbA1c was similar among all three puberty groups (8.4+/-1.4). Lower levels of child-reported DM-specific family conflict, more frequent BGM, and CSII use were significantly associated with lower HbA1c (R2 = 0.20, p <0.001).


CONCLUSIONS
Although glycemic control was not significantly worse in midpubertal and post-pubertal patients, family involvement for DM management and adherence to BGM were lower in late adolescence. Interventions to optimize glycemic control may include minimizing DM-specific conflict, increasing BGM frequency, and implementing CSII use.
Moreland
Elaine C
EC
Pediatric and Adolescent Unit, Behavioral Research and Mental Health Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA.
Tovar
Alison
A
Zuehlke
Jessica B
JB
Butler
Deborah A
DA
Milaszewski
Kerry
K
Laffel
Lori M B
LM
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005195:Family Relations; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D010290:Parents; D011627:Puberty / Q000502:physiology; D012741:Sexual Maturation; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin