Self-care autonomy and outcomes of intensive therapy or usual care in youth with type 1 diabetes.
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.
Wysocki
Tim
T
Center for Pediatric Psychology Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, Florida 32207, USA. twysocki@nemours.org
Harris
Michael A
MA
Buckloh
Lisa M
LM
Wilkinson
Karen
K
Sadler
Michelle
M
Mauras
Nelly
N
White
Neil H
NH
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
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin