title: Prediction of adolescents' glycemic control 1 year after diabetes-specific family conflict: the mediating role of blood glucose monitoring adherence.
abstract: OBJECTIVE
  To test adherence to blood glucose monitoring (BGM) as a mediator between diabetes-specific family conflict and glycemic control (hemoglobin A(1c) [HbA(1c)] levels) for 1 year.
  
  
  METHODS
  Three waves of prospective data spanning 1 year.
  
  
  METHODS
  Diabetes clinic in a large tertiary care children's hospital in the Midwestern United States.
  
  
  METHODS
  One hundred forty-five dyads composed of an adolescent (aged 13-18 years) with type 1 diabetes mellitus and a parent.
  
  
  METHODS
  Adolescent- and parent-rated diabetes-specific family conflict and mean daily BGM frequency obtained through meter downloads.
  
  
  METHODS
  Levels of HbA(1c), abstracted from the medical record.
  
  
  RESULTS
  In separate general linear models, higher adolescent-rated family conflict scores at baseline predicted less frequent BGM at 6 months (β = -0.08 [P = .01]) and higher HbA(1c) levels at 12 months (β = 0.08 [P = .02]). In the multivariate model including baseline conflict and BGM as predictors of HbA(1c) levels, BGM was a significant predictor (β = -0.24 [P = .007]) and conflict was no longer significant (β = 0.05 [P = .11]), supporting the mediation hypothesis. Post hoc probing showed that BGM explained 24% of the variance in the conflict-HbA(1c) link. The mediation between parent-reported conflict and HbA(1c) levels via BGM adherence was partially supported (conflict predicting HbA(1c) in the zero-order equation, β = -0.24 [P = .004]; multivariate equation, β = 0.06 [P = .02]), and BGM frequency explained 16% of the conflict-HbA(1c) link.
  
  
  CONCLUSIONS
  Diabetes-specific family conflict in adolescence predicts deteriorations in BGM and subsequent glycemic control for at least 1 year. Results support ongoing intervention research designed to reduce family conflict and thus prevent a trajectory of declining adherence and glycemic control across adolescence.
authors: Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-management, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229, USA.
authors: Marisa E
authors: ME
authors: Hilliard
authors: Shanna M
authors: SM
authors: Guilfoyle
authors: Lawrence M
authors: LM
authors: Dolan
authors: Korey K
authors: KK
authors: Hood
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data*; D003220:Conflict, Psychological; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016014:Linear Models; D008297:Male; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D006442:Glycated Hemoglobin