Glycemic Control in Youth with Type 1 Diabetes: Family Predictors and Mediators

Department of Clinical and Health Psychology, University of Florida, PO Box 100165, 101 S. Newell Drive No. 3151, FL, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 09/2008; 33(7):719-27. DOI: 10.1093/jpepsy/jsn012
Source: PubMed


This study examined predictive and mediated relationships among youth perception of critical parenting, Child Behavior Checklist Externalizing Subscale (CBCL) externalizing problem scores, adherence, and (hemoglobin A(1c) HbA(1c)), in youth with type 1 diabetes from low socioeconomic status families.
Caregiver/youth dyads (n = 120) completed diabetes specific measures of family functioning regarding diabetes management and structured adherence interviews. Parents completed the CBCL, while assays of youth HbA(1c) were performed. Analyses were conducted using hierarchical linear regression.
Combined measures predicted 44% of the variance in HbA(1c). Adherence partially mediated critical parenting and HbA(1c), while critical parenting and adherence mediated CBCL externalizing problem scores and HbA(1c). CBCL externalizing problem scores did not mediate critical parenting and HbA1(c).
The presence of youth perceptions of critical parenting and youth externalizing behavior problems may interfere with adherence, leading to increases in HbA(1c).

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Available from: Eric A Storch, Jan 06, 2016
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    • "These problems typically occur in midadolescence [6] and result in poor glycemic control [7– 11]. Externalizing behavior problems (e.g., attention and disruptive behavior complaints) are associated with decreased glycemic control as well [12] [13] [14] [15]. Although behavior problems at diagnosis do not seem to impact lifelong poor glycemic control [16], they have been found to be directly associated with hyperglycemia [15]. "
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    ABSTRACT: Introduction. Previous studies indicated an association between behavior problems (internalizing, externalizing) and glycemic control (HbA1c) in youth with type 1 diabetes (T1D). The aim of this study is to examine if this association is mediated by self-confidence and mismanagement of diabetes. Methods. Problem behavior was assessed with the Strengths and Difficulties Questionnaire. Mediating variables were assessed using the Confidence in Diabetes Self-Care-Youth and Diabetes Mismanagement Questionnaire. HbA1c was derived from hospital charts. Bootstrap mediation analysis for multiple mediation was utilized. Results. 88 youths with T1D, age 11–15 y, participated. The relation between both overall problem behavior and externalizing behavior problems and HbA1c was mediated through confidence in diabetes self-care and mismanagement (í µí±Ž 1 í µí± 1 + í µí±Ž 2 í µí± 2 path; point estimate = 0.50 BCa CI 95% 0.25–0.85; í µí±Ž 1 í µí± 1 +í µí±Ž 2 í µí± 2 path; point estimate = 0.73 BCa CI 95% 0.36–1.25). Conclusions. Increased problem behavior in youth with T1D is associated with elevated HbA1c and mediated by low self-confidence and diabetes mismanagement. Screening for problem behavior and mismanagement and assisting young patients in building confidence seem indicated to optimize glycemic control.
    Full-text · Article · May 2015 · Journal of Diabetes Research
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    • "This has led to the development of therapeutic interventions aimed at teaching and motivating parents to use more effective discipline strategies (Forgatch & Patterson, 2010). Coercive family interaction has also been implicated in other problems as well such as poor adherence to complex glycemic control regimens for managing type 1 diabetes (Duke et al., 2008). Finally, there is evidence to suggest that extreme coercive parent–child interaction in the family leads to exaggerated responses to stress. "
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    ABSTRACT: Demonstrate multivariate multilevel survival analysis within a larger structural equation model. Test the 3 hypotheses that when confronted by a negative parent, child rates of angry, sad/fearful, and positive emotion will increase, decrease, and stay the same, respectively, for antisocial compared with normal children. This same pattern will predict increases in future antisocial behavior. Parent-child dyads were videotaped in the fall of kindergarten in the laboratory and antisocial behavior ratings were obtained in the fall of kindergarten and third grade. Kindergarten antisocial predicted less child sad/fear and child positive but did not predict child anger given parent negative. Less child positive and more child neutral given parent negative predicted increases in third-grade antisocial behavior. The model is a useful analytic tool for studying rates of social behavior. Lack of positive affect or excess neutral affect may be a new risk factor for child antisocial behavior.
    Full-text · Article · Oct 2013 · Journal of Pediatric Psychology
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    • "respectively; Waller et al., 1986). Previous research supports the importance of the warmth/caring and guidance/control subscales in impacting glycemic control, but little research has been conducted with the problem solving subscale (e.g., Duke et al., 2008). As such, this subscale was not used in this study. "
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    ABSTRACT: This study examined relations among diabetes-specific family factors, adherence to medical regimen, quality of life (QOL), and glycemic control in youth and adolescents with type 1 diabetes. During an endocrinologist visit, patient and parent–caregiver dyads (n = 70) completed family factors and QOL measures and participated in a structured interview to assess medical regimen compliance, and the patient's glycemic control was assessed by a medical professional. Combined measures accounted for 42% of the variance in glycemic control. QOL partially mediated adherence and glycemic control. Ethnic minority status was associated with poorer glycemic control.
    Full-text · Article · Oct 2013 · Children s Health Care
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