title: Demographic risk factors, mediators, and moderators in youths' diabetes metabolic control.
abstract: BACKGROUND
  Socioeconomic status (SES) is one of the most frequently identified and potent predictors of disease morbidity and mortality. It also predicts diabetes care and metabolic control, yet it is often confounded with parental marital status and ethnicity in pediatric samples.
  
  
  OBJECTIVE
  Key demographic risk factors for poorer metabolic control in adolescents with type I diabetes are examined to distinguish their relative effects, along with disease care mediators and family environment moderators.
  
  
  RESULTS
  When SES, ethnicity, and marital status are considered simultaneously with path analysis, living with married biological parents is the sole predictor of better metabolic control in a predominantly middle-class sample. Specifically, adolescents who lived with their biologic parents had glycosylated hemoglobin levels that were approximately .5% lower on average than those who lived in alternative family arrangements (i.e., blended and single-parent families). More frequent meals and snacks and more blood glucose monitoring mediates this effect. Under favorable conditions of greater familial harmony, children from married biologic families experience a stronger beneficial health effect, with average glycohemoglobin levels that are approximately .81% lower in less conflicted families and .62% lower in more cohesive families.
  
  
  CONCLUSIONS
  In toto, marital status eclipsed the well known effects of SES in the prediction of metabolic control in a primarily middle-class sample of children with diabetes. The 8.0% average glycohemoglobin level of youths from married biologic families is similar to that of intensively treated adolescents in the Diabetes Control and Complications Trial and, if maintained, should be associated with clinically significant reductions in disease complications.
authors.affiliation: Department of Psychiatry, Georgetown University, USA.
authors.forename: Erika E
authors.initials: EE
authors.lastname: Swift
authors.forename: Rusan
authors.initials: R
authors.lastname: Chen
authors.forename: Alyssa
authors.initials: A
authors.lastname: Hershberger
authors.forename: Clarissa S
authors.initials: CS
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D002648:Child; D003220:Conflict, Psychological; D003710:Demography; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D017533:Marital Status; D010290:Parents; D011237:Predictive Value of Tests; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin