title: Self-care autonomy and outcomes of intensive therapy or usual care in youth with type 1 diabetes.
abstract: OBJECTIVE
  This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA(1C)) in 142 youths with diabetes.
  
  
  METHODS
  Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR.
  
  
  RESULTS
  Higher baseline AMR was associated with higher baseline HbA(1C) for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT.
  
  
  CONCLUSIONS
  Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.
authors.affiliation: Center for Pediatric Psychology Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, Florida 32207, USA. twysocki@nemours.org
authors.forename: Tim
authors.initials: T
authors.lastname: Wysocki
authors.forename: Michael A
authors.initials: MA
authors.lastname: Harris
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Buckloh
authors.forename: Karen
authors.initials: K
authors.lastname: Wilkinson
authors.forename: Michelle
authors.initials: M
authors.lastname: Sadler
authors.forename: Nelly
authors.initials: N
authors.lastname: Mauras
authors.forename: Neil H
authors.initials: NH
authors.lastname: White
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D003927:Diet, Diabetic / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D010348:Patient Care Team; D010353:Patient Education as Topic; D026684:Personal Autonomy; D012017:Referral and Consultation; D012648:Self Care / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin