Blood glucose monitoring and glycemic control in adolescence: contribution of diabetes-specific responsibility and family conflict.
OBJECTIVE
To examine age and time trends in responsibility for diabetes management tasks and diabetes-specific family conflict and their relationship to blood glucose monitoring (BGM) frequency and blood glucose control (HbA1c).


METHODS
A sample of 147 adolescents (mean = 15.5 +/- 1.4 years) with type 1 diabetes and their caregivers completed measures of diabetes-specific responsibility and family conflict at baseline and 6 months. BGM frequency and HbA1c were measured during outpatient clinic appointments.


RESULTS
Responsibility for diabetes management tasks shifted from caregivers to adolescents with increasing age by adolescent and caregiver report. Diabetes-specific conflict was stable. Similar trends in responsibility and conflict were seen over the 6-month follow-up period. Less frequent BGM and higher HbA1c were also observed with increasing adolescent age. Multivariate analyses demonstrated adolescents taking greater responsibility for management tasks and experiencing greater family conflict at baseline reported lower BGM at 6 months. Family, demographic, psychosocial, and disease-specific variables accounted for 26% of the variance in BGM frequency by both adolescent and caregiver report. Adolescents reporting greater diabetes-specific family conflict at baseline experienced higher HbA1c values at 6 months. Variables accounted for 23% and 28% of the variance in HBA1c by adolescent and caregiver report respectively.


CONCLUSIONS
Diabetes-specific responsibility and conflict have important implications for improving disease outcomes. Interventions targeting responsibility and conflict (i.e., reducing conflict while keeping caregivers involved in diabetes management) may help prevent the deterioration in BGM and HbA1c frequently seen during adolescence.
Ingerski
Lisa M
LM
Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Anderson
Barbara J
BJ
Dolan
Lawrence M
LM
Hood
Korey K
KK
D000293:Adolescent; D001294:Attitude to Health; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012646:Self Administration; D012648:Self Care
D001786:Blood Glucose