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

https://doi.org/10.1016/j.jadohealth.2012.05.009Get rights and content

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.

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).

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