Original articlePredictors of Deteriorations in Diabetes Management and Control in Adolescents With Type 1 Diabetes
Section snippets
Participants
Participants were adolescents aged between 13 and 18 years diagnosed with type 1 diabetes (mean age = 15.5 ± 1.4 years) receiving multidisciplinary care for type 1 diabetes at a tertiary pediatric medical center. We approached 166 families to participate in the study, and enrolled and collected baseline data from 150 (90% recruitment rate). Retention rates were 98% at the second visit, 97% at the third visit, and 89% at the fourth visit. Attrition was generally because of an inability to make
Subgroup identification
Using trajectory modeling, we examined three unique solutions consisting of two, three, and four subgroups, respectively (Table 1). The three-group solution provided the best statistical fit to the data, based on (1) a Bayesian Information Criterion of 4,245.2 and (2) sufficiently large subgroups (≥10% of sample/subgroup). Nagin's diagnostics [27] confirmed the adequacy of the three-group solution (Table 2).
The characteristics of each subgroup are summarized in Table 3, and the diabetes
Discussion
Observations from large-scale clinical and epidemiological studies [8] were replicated across a 2-year period in late adolescence, with 60% of the sample demonstrating diabetes management and control outside of ADA-recommended ranges. A portion of the sample was substantially above the recommended range and may be at greatly elevated risk for short- and long-term health complications [2], [10]. At the same time, more than one-third of the sample demonstrated BGM frequency rates and A1c values
Acknowledgments
This research was supported by a career development award from the National Institutes of Health to K.K.H. (K23, DK077340).
References (38)
- et al.
Prevalence and predictors of pervasive noncompliance with medical treatment among youths with insulin-dependent diabetes mellitus
J Am Acad Child Adolesc Psychiatry
(1992) - et al.
Depression in type 1 diabetes in children: Natural history and correlates
J Psychosom Res
(2002) - et al.
Treatment of depression in diabetes: Impact on mood and medical outcome
J Psychosom Res
(2002) - et al.
Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association
Diabetes Care
(2005) - et al.
Clinical and psychological course of diabetes from adolescence to young adulthood: A longitudinal cohort study
Diabetes Care
(2001) - et al.
A longitudinal analysis of adherence and health status in childhood diabetes
J Pediatr Psychol
(1992) - et al.
Predictors of metabolic control among adolescents with diabetes: A 4-year longitudinal study
J Pediatr Psychol
(2009) - et al.
A focus on blood glucose monitoring: Relation to glycemic control and determinants of frequency
Pediatr Diabetes
(2011) - et al.
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) - et al.
Glycemic control in youth with diabetes: The SEARCH for diabetes in youth study
J Pediatr
(2009)