title: Identification and prediction of group-based glycemic control trajectories during the transition to adolescence.
abstract: OBJECTIVE
  To identify trajectories of glycemic control over a period of 3 years in a pediatric sample of youth diagnosed with Type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family level baseline predictors of glycemic control group membership.
  
  
  METHODS
  This multisite, prospective study included 239 children and adolescents (ages 9-11 years at baseline) diagnosed with Type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at 6-month intervals over a period of 3 years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates.
  
  
  RESULTS
  Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and 3 trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high-risk group membership.
  
  
  CONCLUSIONS
  These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Rohan
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Rausch
authors.affiliation: Division of Behavioral Health, Alfred I. DuPont Hospital for Children.
authors.forename: Jennifer Shroff
authors.initials: JS
authors.lastname: Pendley
authors.affiliation: Department of Pediatrics, University of Miami.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Delamater
authors.affiliation: Department of Endocrinology, Cincinnati Children's Hospital Medical Center.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Dolan
authors.affiliation: Division of Pediatric Endocrinology, Alfred I. DuPont Hospital for Children.
authors.forename: Grafton
authors.initials: G
authors.lastname: Reeves
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center.
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy; D056344:Executive Function; D054541:Family Conflict / Q000523:psychology; D005260:Female; D005544:Forecasting; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D009034:Mother-Child Relations / Q000523:psychology*; D015337:Multicenter Studies as Topic; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin