title: Modeling predictors of changes in glycemic control and diabetes-specific quality of life amongst adults with type 1 diabetes 1 year after structured education in flexible, intensive insulin therapy.
abstract: Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14-20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower 'perceived diabetes seriousness', greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in self-management programs is recommended.
authors.affiliation: School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK. d.cooke@surrey.ac.uk.
authors.forename: Debbie
authors.initials: D
authors.lastname: Cooke
authors.affiliation: School of Psychology, University of Sussex, Brighton, UK.
authors.forename: Rod
authors.initials: R
authors.lastname: Bond
authors.affiliation: Department of Population Health Sciences, Edinburgh University, Edinburgh, Scotland, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Lawton
authors.affiliation: Department of Population Health Sciences, Edinburgh University, Edinburgh, Scotland, UK.
authors.forename: David
authors.initials: D
authors.lastname: Rankin
authors.affiliation: Academic Unit of Diabetes, University of Sheffield, Sheffield, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Heller
authors.affiliation: Epidemiology and Public Health, University College London, London, UK.
authors.forename: Marie
authors.initials: M
authors.lastname: Clark
authors.affiliation: AHP Research, Hornchurch, UK.|The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia - Vic, Melbourne, VIC, Australia.|Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Diabetes; Glycemic control; Quality of life; Self-management