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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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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