title: Low Self-Confidence and Diabetes Mismanagement in Youth with Type 1 Diabetes Mediate the Relationship between Behavioral Problems and Elevated HbA1c.
abstract: BACKGROUND
  Previous studies indicated an association between behavior problems (internalizing, externalizing) and glycemic control (HbA1c) in youth with type 1 diabetes (T1D). The aim of this study is to examine if this association is mediated by self-confidence and mismanagement of diabetes.
  
  
  METHODS
  Problem behavior was assessed with the Strengths and Difficulties Questionnaire. Mediating variables were assessed using the Confidence in Diabetes Self-Care-Youth and Diabetes Mismanagement Questionnaire. HbA1c was derived from hospital charts. Bootstrap mediation analysis for multiple mediation was utilized.
  
  
  RESULTS
  88 youths with T1D, age 11-15 y, participated. The relation between both overall problem behavior and externalizing behavior problems and HbA1c was mediated through confidence in diabetes self-care and mismanagement (a 1 b 1 + a 2 b 2 path; point estimate = 0.50 BCa CI 95% 0.25-0.85; a 1 b 1 + a 2 b 2 path; point estimate = 0.73 BCa CI 95% 0.36-1.25).
  
  
  CONCLUSIONS
  Increased problem behavior in youth with T1D is associated with elevated HbA1c and mediated by low self-confidence and diabetes mismanagement. Screening for problem behavior and mismanagement and assisting young patients in building confidence seem indicated to optimize glycemic control.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands ; EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands.
authors.forename: Minke M A
authors.initials: MM
authors.lastname: Eilander
authors.affiliation: Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands ; EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: de Wit
authors.affiliation: EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands ; Department of Pediatrics, VU Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Rotteveel
authors.affiliation: Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands ; EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands ; Department of Medical Psychology, Academic Medical Center (AMC), Meibergdreef 9, 1100 DD Amsterdam, Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D000066553:Problem Behavior / Q000523:psychology*; D012649:Self Concept; D012919:Social Behavior
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human