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

• Published in: Journal of adolescent health Vol. 52; no. 1; pp. 28 - 34
• Main Authors: Hilliard, Marisa E., Ph.D, Wu, Yelena P., Ph.D, Rausch, Joseph, Ph.D, Dolan, Lawrence M., M.D, Hood, Korey K., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-01-2013; Elsevier
• Subjects: Adolescent; Adolescents; Biological and medical sciences; Blood Glucose - analysis; Blood glucose monitoring; Blood Glucose Self-Monitoring; Caregivers; Conflicts; Demography; Depression; Diabetes mellitus; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - therapy; Diabetes. Impaired glucose tolerance; Disease management; Distress; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Family Conflict; Female; Glucose; Glycated Hemoglobin A - analysis; Glycemic control; Humans; Insulin; Intervention; Male; Medical sciences; Membership; Parents; Patient Compliance; Pediatrics; Prevention; Prognosis; Prospective Studies; Psychology; Risk Factors; Signals; Surveys and Questionnaires; Type 1 diabetes; Type 1 diabetes mellitus; Glycemic control; Depression; Distress; Type 1 diabetes; Family conflict; Blood glucose monitoring; Endocrinopathy; Human; Immunopathology; Autoimmune disease; Parent child relation; Social interaction; Conflict; Deterioration; Adolescent; Family environment; Predictive factor; Glycemia; Monitoring
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2012.05.009

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.