title: Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model.
abstract: The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N = 226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9-11 years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1 year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1 year later (p < 0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. dennis.drotar@cchmc.org
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
authors.forename: Richard
authors.initials: R
authors.lastname: Ittenbach
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Rohan
authors.forename: Resmi
authors.initials: R
authors.lastname: Gupta
authors.forename: Jennifer Shroff
authors.initials: JS
authors.lastname: Pendley
authors.forename: Alan
authors.initials: A
authors.lastname: Delamater
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000628:therapy*; D054541:Family Conflict / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008960:Models, Psychological; D026684:Personal Autonomy; D011446:Prospective Studies; D011627:Puberty / Q000523:psychology; D012307:Risk Factors; D012648:Self Care / Q000523:psychology*; D014481:United States
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human