title: Longitudinal associations between sex, diabetes self-care, and health-related quality of life among youth with type 1 or type 2 diabetes mellitus.
abstract: OBJECTIVE
  To examine the longitudinal associations between sex, diabetes self-care, and the health-related quality of life (HRQL) of children and adolescents with type 1 or type 2 diabetes.
  
  
  METHODS
  The sample included 910 participants with type 1 and 241 participants with type 2, ages 10-22 years at baseline, from the SEARCH for Diabetes in Youth Study, a longitudinal observational study. The primary outcome measure was the Pediatric Quality of Life Inventory. Repeated measures, mixed-model regression analysis was conducted with the use of data from baseline and at least one follow-up assessment, spanning approximately 4 years.
  
  
  RESULTS
  HRQL was greater among those with type 1 versus type 2 diabetes. Among participants with type 1, greater (better) Pediatric Quality of Life Inventory total scores over time were related to greater parent education (P = .0007), lower glycated hemoglobin values (P < .0001), and greater physical activity during the past 7 days (P = .0001). There was a significant interaction between sex and age (P < .0001); girls' HRQL remained stable or decreased over time, whereas males' HRQL increased. For participants with type 2 diabetes, there was no significant interaction by age and sex, but lower total HRQL was related to being female (P = .011) and greater body mass index z-scores (P = .014).
  
  
  CONCLUSIONS
  HRQL in this cohort varied by diabetes type. The interaction between sex and age for type 1 participants, coupled with poorer HRQL among female than male participants with type 2 diabetes, suggests the impacts of diabetes on HRQL differ by sex and should be considered in clinical management. Encouraging physical activity and weight control continue to be important in improving HRQL.
authors.affiliation: Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest Medical School, Winston-Salem, NC. Electronic address: naughton@wakehealth.edu.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Naughton
authors.affiliation: Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Yi-Frazier
authors.affiliation: Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Michael
authors.initials: M
authors.lastname: Seid
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.affiliation: Barbara Davis Center, University of Colorado School of Medicine, Denver, CO.
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
authors.affiliation: Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Standiford
authors.affiliation: Seattle Children's Research Institute, Endocrinology, Seattle, WA.
authors.forename: Beth
authors.initials: B
authors.lastname: Loots
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001294:Attitude to Health; D015992:Body Mass Index; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D015444:Exercise; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011788:Quality of Life; D012648:Self Care / Q000592:standards* / Q000639:trends; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents