Original article| Volume 52, ISSUE 1, P28-34, January 2013

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Predictors of Deteriorations in Diabetes Management and Control in Adolescents With Type 1 Diabetes

  • Marisa E. Hilliard
    Department of Medicine, Johns Hopkins Adherence Research Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Yelena P. Wu
    Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Joseph Rausch
    Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Lawrence M. Dolan
    Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

    Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Korey K. Hood
    Address correspondence to: Korey K. Hood, Ph.D., The Madison Clinic for Pediatric Diabetes, University of California, San Francisco, 400 Parnassus Avenue, 4th Floor, UCSF Mail Box 0318, San Francisco, CA 94143-0318
    Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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      Deteriorating type 1 diabetes management and control are common among adolescents; however, clinical evidence suggests that individual trajectories can vary. The aim of this study was to examine patterns and predictors of blood glucose monitoring (BGM) frequency and glycemic control (hemoglobin A1c).


      Prospective data analysis spanning 18–24 months was conducted with 150 adolescent–parent pairs. Latent group-based trajectory modeling identified subgroups and determined medical, demographic, psychological, and family predictors of subgroup membership.


      Three subgroups emerged, representing diabetes management and control that are “meeting treatment targets” (40%; A1c at baseline = 7.4%, BGM frequency at baseline = 4.8 checks/day) and two levels “not meeting targets”:“normatively similar” youth (40%; A1c = 9.2%, BGM frequency = 2.8 checks/day), and “high-risk” youth (20%; A1c = 11.2%, BGM frequency = 2.9 checks/day). Subgroup membership was maintained over 18–24 months. There was minimal change across time, although only one-third of adolescents met treatment targets. Older age, longer diabetes duration, ethnic minority status, unmarried caregiver status, insulin delivery via injections versus continuous subcutaneous insulin infusion, greater depressive symptoms, negative affect about BGM, and diabetes-specific family conflict each predicted membership in a subgroup with poorer diabetes management and control.


      Among the nearly two-thirds of adolescents with management and control that do not meet treatment targets, modifiable and nonmodifiable factors may signal the need for prevention or intervention. Demographic and medical factors may call for proactive efforts to prevent deterioration, and psychological symptoms and family conflict signal opportunities for clinical intervention to promote improved diabetes management and control in adolescence.


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      Linked Article

      • Improving Adherence Among Adolescents With Type 1 Diabetes
        Journal of Adolescent HealthVol. 52Issue 1
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          Meeting the many demands of managing type 1 diabetes (T1D) is difficult, even for motivated adults. Numerous glucose checks, consideration of insulin dosing, diet and exercise, managing logistics of care, and problem solving all require some degree of attention and energy around the clock every day of the year. For adolescents, these burdens may be particularly onerous [1], coming at a time in social and cognitive development associated with spontaneity, increasing independence, and still developing executive function.
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