title: Self-management behaviors, racial disparities, and glycemic control among adolescents with type 2 diabetes.
abstract: OBJECTIVE
  Type 2 diabetes is a growing problem among adolescents, but little is known about self-management behaviors in this population. Our aim was to examine self-management behaviors and glycemic control among adolescents with type 2 diabetes.
  
  
  METHODS
  From 2003 to 2005, a telephone survey of adolescents with type 2 diabetes was performed. Chart review obtained most recent glycated hemoglobin and clinical characteristics. Analyses compared patient characteristics and self-management behaviors to recent glycated hemoglobin levels.
  
  
  RESULTS
  Of 139 patients contacted, 103 (74%) completed the study. The mean age was 15.4 years: 69% were girls, 47% were white, and 46% were black. Mean glycated hemoglobin was 7.7%, and the average duration of diabetes was 2.0 years. More than 80% of patients reported > or = 75% medication compliance, and 59% monitored blood glucose > 2 times daily. However, patients reported frequent episodes of overeating, drinking sugary drinks, and eating fast food. More than 70% of patients reported exercising > or = 2 times a week, but 68% reported watching > or = 2 hours of television daily. Nonwhite patients had higher glycated hemoglobin and hospitalizations per year compared with white patients. In multivariable analyses, nonwhite race remained significantly associated with higher glycated hemoglobin even after adjusting for age, gender, BMI, insurance status, and other factors. Nonwhite patients were more likely to watch > or = 2 hours of television per day (78% vs 56%), to report exercising < or = 1 time per week (35% vs 21%), and to drink > or = 1 sugary drink daily (27% vs 13%).
  
  
  CONCLUSIONS
  Although patients reported good medication and monitoring adherence, they also reported poor diet and exercise habits and multiple barriers. Nonwhite race was significantly associated with poorer glycemic control even after adjusting for covariates. This may, in part, be related to disparities in lifestyle behaviors. Additional studies are indicated to further assess self-management behaviors and potential racial disparities in adolescents with type 2 diabetes.
authors.affiliation: Vanderbilt Center for Health Services Research, Suite 6000 Medical Center East, Nashville, TN 37232-8300, USA. russell.rothman@vanderbilt.edu
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
authors.forename: Shelagh
authors.initials: S
authors.lastname: Mulvaney
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.forename: Ann
authors.initials: A
authors.lastname: VanderWoude
authors.forename: Tebeb
authors.initials: T
authors.lastname: Gebretsadik
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.forename: Amy
authors.initials: A
authors.lastname: Potter
authors.forename: William E
authors.initials: WE
authors.lastname: Russell
authors.forename: David
authors.initials: D
authors.lastname: Schlundt
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D001294:Attitude to Health; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D003927:Diet, Diabetic / Q000379:methods / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D054624:Health Status Disparities; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D044469:Racial Groups / Q000523:psychology; D012648:Self Care / Q000379:methods* / Q000523:psychology*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents