Abstract
Purpose
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).
Methods
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.
Results
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.
Conclusions
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.
Keywords
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References
- Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association.Diabetes Care. 2005; 28: 186-212
- Clinical and psychological course of diabetes from adolescence to young adulthood: A longitudinal cohort study.Diabetes Care. 2001; 24: 1536-1540
- A longitudinal analysis of adherence and health status in childhood diabetes.J Pediatr Psychol. 1992; 17: 537-553
- Predictors of metabolic control among adolescents with diabetes: A 4-year longitudinal study.J Pediatr Psychol. 2009; 34: 254-270
- A focus on blood glucose monitoring: Relation to glycemic control and determinants of frequency.Pediatr Diabetes. 2011; 12: 25-30
- Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus.J Am Acad Child Adolesc Psychiatry. 1992; 31: 1112-1119
- Continuity and change in glycemic control trajectories from adolescence to emerging adulthood: Relationships with family climate and self-concept in type 1 diabetes.Diabetes Care. 2009; 32: 797-801
- Glycemic control in youth with diabetes: The SEARCH for diabetes in youth study.J Pediatr. 2009; 155: 668-672
- Effect of improved glycemic control on health care costs and utilization.JAMA. 2001; 285: 182-189
- Identification of self-management patterns in pediatric type 1 diabetes using cluster analysis.Pediatr Diabetes. 2011; 12: 611-618
- Trajectories of glycemic control over early to middle adolescence.J Pediatr Psych. 2010; 35: 1161-1167
- Personalized care planning for diabetes: Policy lessons from systematic reviews of consultation and self-management interventions.Prim Health Care Res Dev. 2009; 10: 210-222
- Association between adherence and glycemic control in pediatric type 1 diabetes: A meta-analysis.Pediatrics. 2009; 124: e1171-e1179
- Impaired insulin action in puberty: A contributing factor to poor glycemic control in adolescents with diabetes.N Engl J Med. 1986; 315: 215-219
- Family conflict, adherence, and glycaemic control in youth with short duration type 1 diabetes.Diabet Med. 2002; 19: 635-642
- Depressive symptoms and glycemic control in adolescents with type 1 diabetes: Mediational role of blood glucose monitoring.Diabetes Care. 2009; 32: 804-806
- Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the diabetes control and complications trial (DCCT).J Pediatr. 2001; 139: 804-812
- Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: Rates, magnitude, and moderators of change.Pediatr Diabetes. 2011; 12: 718-723
- The Children's Depression, Inventory (CDI).Psychopharmacol Bull. 1985; 21: 995-998
- Major depressive disorder in youths with IDDM.Diabetes Care. 1997; 20: 45-51
- Depression in type 1 diabetes in children: Natural history and correlates.J Psychosom Res. 2002; 53: 907-911
- The blood glucose monitoring communication questionnaire: An instrument to measure affect specific to blood glucose monitoring.Diabetes Care. 2004; 27: 2610-2615
- Updated and revised diabetes family conflict scale.Diabetes Care. 2007; 30: 1764-1769
- Family conflict and diabetes management in youth: Clinical lessons from child development and diabetes research.Diabetes Spec. 2004; 17: 22-26
- Family environment and glycemic control: A four-year prospective study of children and adolescents with insulin-dependent diabetes mellitus.Psychosom Med. 1994; 56: 401-409
- Mplus User's Guide.Sixth Edition. Muthén and Muthén, Los Angeles, CA1998-2010
- Group-Based Modeling of Development.Harvard University Press, Cambridge, MA2005
- Use of insulin pump therapy in the pediatric age-group: Consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes.Diabetes Care. 2007; 30: 1653-1662
- Health beliefs and regimen adherence in minority adolescents with type 1 diabetes.J Pediatr Psychol. 2005; 30: 503-512
- Demographic risk factors, mediators, and moderators in youths' diabetes metabolic control.Ann Behav Med. 2006; 32: 355-365
- The impact of modifiable family factors on glycemic control among youth with type 1 diabetes.Pediatr Diabetes. 2008; 9: 373-381
- Evidence-based psychosocial treatments for child and adolescent depression.J Clin Child Adolesc Psychol. 2008; 37: 62-104
- Treatment of depression in diabetes: Impact on mood and medical outcome.J Psychosom Res. 2002; 53: 917-924
- Use of a blood glucose monitoring manual to enhance monitoring adherence in adults with diabetes: A randomized controlled trial.Arch Intern Med. 2006; 166: 689-695
- An office-based intervention to maintain parent-adolescent teamwork in diabetes management: Impact on parent involvement, family conflict, and subsequent glycemic control.Diabetes Care. 1999; 22: 713-721
- Randomized trial of behavioral family systems therapy for diabetes: Maintenance of effects on diabetes outcomes in adolescents.Diabetes Care. 2007; 30: 555-560
- Pediatric psychosocial preventive health model (PPPHM): Research, practice, and collaboration in pediatric family systems medicine.Fam Sys. Health. 2006; 24: 381-395
- Cross-sectional study into quality of life issues surrounding insulin pump use in type 1 diabetes.Pract Diabetes. 2008; 25: 194-200
Article info
Publication history
Published online: July 16, 2012
Accepted:
May 17,
2012
Received:
February 21,
2012
Identification
Copyright
© 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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- Improving Adherence Among Adolescents With Type 1 DiabetesJournal of Adolescent HealthVol. 52Issue 1
- PreviewMeeting 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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