title: How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control.
abstract: OBJECTIVE
  Detriments in quality of life (QOL) may contribute to the common, costly decline in adolescents' type 1 diabetes management and control, yet we know little about how this might happen.
  
  
  METHODS
  Participants were 150 adolescents (age 13-18) with type 1 diabetes and their parents. We constructed a latent QOL variable from a multi-informant, multi-domain assessment when participants entered the study. The QOL variable was examined in relation to prospective assessments of diabetes management (blood glucose monitoring frequency; BGM) and control (hemoglobin A1c). We used an indirect path model to test the links among these variables, using bias-corrected bootstrapping.
  
  
  RESULTS
  Poorer QOL at baseline was indirectly linked with higher A1c at 12 months via less frequent BGM obtained at 6 months (b = -0.01, 95% CI = -0.025, -0.004, p < 0.05). Older age (b = -0.32), longer diabetes duration (b = -0.07), and insulin delivery via injections versus the insulin pump (b = 0.67) were covariates of less frequent BGM, and unmarried caregiver status was associated with higher A1c (b = -0.76), all ps < 0.05.
  
  
  CONCLUSIONS
  In this study, poorer QOL acted as a barrier to effective diabetes management, subsequently altering diabetes control.
  
  
  CONCLUSIONS
  Efforts to monitor and enhance QOL may hold promise for improving adolescents' diabetes outcomes in the future.
authors.affiliation: Johns Hopkins Adherence Research Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Hilliard
authors.forename: Krista A
authors.initials: KA
authors.lastname: Mann
authors.forename: James L
authors.initials: JL
authors.lastname: Peugh
authors.forename: Korey K
authors.initials: KK
authors.lastname: Hood
mesh_terms: D002755:Choice Behavior; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D014956:Writing