title: Type 1 diabetes among adolescents: reduced diabetes self-care caused by social fear and fear of hypoglycemia.
abstract: The aim of this study was to examine the association between social anxiety and adherence to diabetes self-care and quality of life and to determine the effects of fear of hypoglycemia on these associations in adolescents with type 1 diabetes. It is hypothesized that (1) social anxiety will be negatively associated with adherence and quality of life and (2) that fear of hypoglycemia will mediate this relationship. It is also hypothesized that (3) girls will have higher social anxiety than boys.
  
  
  
  Adolescents with type 1 diabetes were recruited during clinic visits at 2 international centers. Participants answered a survey containing questionnaires on social anxiety, behavioral adherence to the diabetes self-care regimen, quality of life, fear of hypoglycemia, and last hemoglobin A1C results.
  
  
  
  Seventy-six adolescents (33 boys, 43 girls), mean age 15.9 (1.44) years, participated. Social anxiety levels are not statistically different between genders. In boys, social anxiety is associated with worse diet and insulin injection adherence; no associations are found in girls. Social anxiety is positively correlated with poor quality of life in both genders. Fear of hypoglycemia mediates the relationship between social anxiety and insulin adherence in boys.
  
  
  
  Findings suggest that social anxiety, which is common in general populations of adolescents, may interfere with behavioral adherence and quality of life among adolescents with type 1 diabetes. Screening and treatment of social anxiety may result in better adherence and increased quality of life.
authors.affiliation: University of Melbourne, Department of Psychology, Melborne, Australia (Ms Di Battista)
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Di Battista
authors.affiliation: Ryerson University, Toronto, Ontario, Canada (Dr Hart)
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Hart
authors.affiliation: University of Missouri—Saint Louis, Department of Psychology, Saint Louis, Missouri (Dr Greco)
authors.forename: Laurie
authors.initials: L
authors.lastname: Greco
authors.affiliation: North York General Hospital, Diabetes Education Centre, Branson Site, Toronto, Ontario, Canada (Ms Gloizer)
authors.forename: Jan
authors.initials: J
authors.lastname: Gloizer