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Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model

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Abstract

The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N = 226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9–11 years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1 year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1 year later (p < 0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.

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Acknowledgments

The work reported in this article was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (1R01 DK069486). The HbA1c data was analyzed by the Diabetes Diagnostic Laboratory (DCD) at the University of Missouri Columbia Health Sciences Center. Data collection and management of this study were facilitated by a talented group of research assistants, including Claire Peterson, Michelle Eakin, Danielle Rosnov, Daniela Fernandez, Jennifer Hernandez, Katharina Wetterau, Erica Sood, Megan Miller, and Andrea Perry. We very much appreciated the efforts of a talented group of undergraduate research assistants who coded the videotapes of the problem-solving interactions, as well as, the support from Dr. Larry Dolan and Grafton Reeves, who were the endocrinologists that collaborated on the study. Finally, the efforts of study participants who gave their time and energy to this work are gratefully acknowledged.

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Authors and Affiliations

  1. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Dennis Drotar & Jennifer M. Rohan

  2. Department of Psychology, University of Cincinnati, Cincinnati, OH, USA

    Dennis Drotar & Jennifer M. Rohan

  3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Richard Ittenbach & Resmi Gupta

  4. Division of Behavioral Health, Alfred I. duPont Hospital for Children, Wilmington, DE, 19803, USA

    Jennifer Shroff Pendley

  5. Department of Pediatrics, University of Miami, Miami, FL, 33136, USA

    Alan Delamater

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  1. Dennis Drotar
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  3. Jennifer M. Rohan
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Correspondence to Dennis Drotar.

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Drotar, D., Ittenbach, R., Rohan, J.M. et al. Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model. J Behav Med 36, 234–245 (2013). https://doi.org/10.1007/s10865-012-9426-0

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  • DOI: https://doi.org/10.1007/s10865-012-9426-0

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