scholarly journals Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes

Author(s):  
Mary E Keenan ◽  
Kristoffer S Berlin ◽  
Jessica L Cook ◽  
Rachel L Ankney ◽  
Kimberly L Klages ◽  
...  

Abstract Objective Following the Journal of Pediatric Psychology’s special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control. Methods One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics. Results Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups. Conclusions Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.

2008 ◽  
Author(s):  
Jonathan M. Kurss ◽  
Anna E. Craig ◽  
Jennifer Reiter-Purtill ◽  
Kathryn Vannatta ◽  
Cynthia Gerhardt

2013 ◽  
Vol 168 (6) ◽  
pp. 861-869 ◽  
Author(s):  
Eva O Melin ◽  
Maria Thunander ◽  
Ralph Svensson ◽  
Mona Landin-Olsson ◽  
Hans O Thulesius

ObjectiveThe aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients.DesignCross-sectional study.MethodsIn this study, 292 patients with type 1 diabetes, aged 18–59 years, participated. Psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected.ResultsSelf-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1c>8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1c>8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1c>8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression.ConclusionsDepression was the only psychological factor independently associated with HbA1c>8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1c>8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.


2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Karishma A. Datye ◽  
Niral J. Patel ◽  
Sarah S. Jaser

Purpose. The current study compares the relative strength of associations of different adherence measures with glycemic control in adolescents with type 1 diabetes, while highlighting the challenges in using more objective measures (i.e., glucometer data). Methods. Adolescents with type 1 diabetes (n=149) and their caregivers completed a questionnaire measure assessing adolescents’ adherence (Self-Care Inventory (SCI)) to the diabetes regimen. Adolescents’ glucometers were downloaded to determine average blood glucose checks per day, as an objective measure of adherence. A measure of glycemic control (hemoglobin A1c (HbA1c)) was obtained as part of adolescents’ regular clinic visits. Results. Adolescents’ self-reported adherence to the treatment regimen was more strongly correlated with HbA1c than caregivers’ reports of adherence. In multivariate analyses, both adolescents’ self-report of adherence and average blood glucose checks per day (obtained via a glucometer) were significant predictors of HbA1c. Challenges to obtaining glucometer data were identified. Conclusions. The findings highlight adolescents’ self-report of adherence using the SCI as a brief and meaningful measure to understand and improve adolescents’ glycemic control, particularly when glucometer data is difficult to obtain.


Psichologija ◽  
2009 ◽  
Vol 40 ◽  
pp. 21-36
Author(s):  
Gintautas Valickas ◽  
Viktorija Tarozienė

Asocialaus elgesio ir socialinės informacijos apdorojimo sąsajas pagrindžia įvairaus amžiaus vaikų ir paauglių tyrimų rezultatai. Tačiau duomenų apie suaugusių teisės pažeidėjų socialinės informacijos apdorojimą vis dar yra labai mažai. Tai apsunkina iškeltų teorinių prielaidų tikrinimą ir tikslinimą, asocialaus elgesio pasireiškimo prognozavimą, efektyvesnių šio elgesio prevencijos programų parengimą.Remiantis sukauptų tyrimų duomenimis, straipsnyje analizuojamos bendrosios socialinės informacijos apdorojimo raidos tendencijos, socialinės informacijos apdorojimo ir asocialaus elgesio ryšiai vaikystėje ir paauglystėje, taip pat brandžiame amžiuje. Tuo remiantis, keliamos prielaidos, kad yra prosocialių ir asocialių asmenų, suaugusiųjų ir vaikų / paauglių, taip pat suaugusių ir nepilnamečių teisės pažeidėjų socialinio žinojimo vienetų ir socialinės informacijos apdorojimo būdų panašumų bei skirtumų, išskiriamos perspektyviausios tyrimų sritys ir svarbiausios problemos.Pagrindiniai žodžiai: socialinės informacijos apdorojimas, socialinio žinojimo vienetai, vaikų / paauglių ir suaugusiųjų asocialus elgesys.Antisocial Behaviour Genesis from the Social Information Processing PerspectiveGintautas Valickas, Viktorija Tarozienė SummaryQuite numerous research findings show that social information processing underlies different forms of prosocial and antisocial behaviour. Although most of data come from research of children of different age, interest in social information processing andbehaviour in later periods of life markedly grows. More and more authors turn to the question of adult social information processing and antisocial behaviour, considering it as a promising field for criminal behaviour forecast and correction. Two aims ofthis paper are: 1) to describe the main developmental features of social information processing from early childhood to late adolescence and early adulthood; 2) to make assumptions on the connections between social information processing and the antisocial (criminal) behaviour of adults. In this article, we review findings of more than two last decades as it is the most intense period for the development of knowledge in this field.Analysis of the literature shows that patterns of social information processing of people with tendencies to prosocial and antisocial behaviour already differ in groups of children. These differences become more vivid in groups of adolescents as theytend to use antisocial thinking strategies more often and in more steps of information processing than younger children. We suppose that adults have similar but even more clear and vivid patterns of specific social information processing and behaviour than adolescents.Social knowledge of adults is more complex, abstract and differentiated to specific social situations in comparison with people of younger age. Moreover, their information processing is more rapid and complex as well as more tendentious andrigid. Automation of information processing might suspend the learning process and be a source of information processing mistakes in new social situations. We assume that adults, in comparison with children, must have a rather stable and effectivelyworking social information processing directly linked to specific forms of prosocial or antisocial behaviour. We hypothesize that because of a longer antisocial (criminal) experience, some specific features of social knowledge and information processingmight appear. Therefore, researches of social information processing that underlie specific forms of antisocial (criminal) behaviour seem to be most informative and useful in this field.Moreover, it is still very little known about the role of emotions in antisocial behaviour genesis. There is some eloquent data on their important impact on social information processing underlying antisocial behaviour, but we suppose that this impactmight differ in particular stages of development. Keywords: social information processing social knowledge, antisocial behaviour of children/adolescents and adults.


2017 ◽  
Author(s):  
Anne-Sophie Brazeau ◽  
Meranda Nakhla ◽  
Michael Wright ◽  
Mélanie Henderson ◽  
Constadina Panagiotopoulos ◽  
...  

BACKGROUND Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices. OBJECTIVE The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control. METHODS Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA1c) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA1c>9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models). RESULTS Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA1c>9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). CONCLUSIONS There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA1c levels and severe hypoglycemia. Targeted strategies to address stigma are needed. CLINICALTRIAL ClinicalTrials.gov NCT02796248; http://clinicaltrials.gov/ct2/show/NCT02796248 (Archived by WebCite at http://www.webcitation.org/6yisxeV0B)


2009 ◽  
Vol 40 (1) ◽  
pp. 95-103 ◽  
Author(s):  
S. Ohmann ◽  
C. Popow ◽  
B. Rami ◽  
M. König ◽  
S. Blaas ◽  
...  

BackgroundThe relationship between metabolic control and cognitive function in adolescents with type 1 diabetes (DM type 1) is not clear. We compared the quality of glycemic control (GC) and cognitive measures in adolescents with DM type 1 to find out if the quality of diabetes management is related to cognitive impairment.MethodWe assessed executive functions (EFs) and other neuropsychological and psychosocial variables in 70 adolescent patients with DM type 1 and 20 age-matched controls. Patients were divided into two groups according to their last hemoglobin A1c (HbA1c): acceptable (HbA1c 5.9–8.0%, mean 6.9%, 36 patients, mean age 14 years) and non-optimal (HbA1c 8.2–11.6%, mean 9.3%, 34 patients, mean age 15.6 years).ResultsWe found impaired EFs, mainly problems of concept formation (p=0.038), cognitive flexibility (p=0.011) and anticipation (p=0.000), in the patients with DM type 1. Both groups did not differ in intelligence, most assessed EFs and adjustment to chronic illness (Youth Self-Report; YSR). Younger patients (<15 years) were cognitively less flexible. GC was worse in older patients and in patients with longer duration of the disease. We also found significant differences between patients with diabetes and controls concerning somatic complaints, internalizing problems (Child Behavior Checklist; CBCL) and social activity (CBCL and YSR).ConclusionsDM type 1 is associated with cognitive deficits in adolescents independent of the quality of metabolic control and the duration of the disease. These deficits are probably related to the disease, especially in patients with early-onset diabetes.


2017 ◽  
Vol 11 (6) ◽  
pp. 443-450
Author(s):  
Termpong Dumrisilp ◽  
Vichit Supornsilchai ◽  
Suttipong Wacharasindhu ◽  
Suphab Aroonparkmongkol ◽  
Taninee Sahakitrungruang

AbstractBackgroundChildren and adolescents with type 1 diabetes mellitus (T1D), even those with intensive insulin treatment regimens, often have higher glycated hemoglobin (HbA1c) levels than adults.ObjectiveTo delineate the medical and psychosocial factors associated with glycemic control in an unselected pediatric population with T1D.MethodsWe included a cross-section of 58 adolescents (28 boys and 30 girls) aged 13.6 ± 4.0 years with T1D ≥1 year attending a well-established pediatric diabetes clinic in Thailand. Median diabetes duration was 4.1 years (range 1–18 years). Participants were divided into 2 subgroups according to their average HbA1clevel over the past year. Those with good control (HbA1c<8%) (n = 13) were compared with those with poor control (HbA1c≥8%) (n = 45). Data collected from self-report standardized questionnaires and medical records were used to compare variables between groups.ResultsAdolescents with good control used significantly less daily insulin and had higher family income, higher scores for family support, and quality of life (QoL) than those in the group with poor control (P< 0.05). Age, sex, puberty, duration of diabetes, insulin regimen, frequency of blood glucose monitoring, and self-report adherence did not differ between groups. By univariate logistic regression, the only factor associated significantly with poor glycemic control was a QoL score <25.ConclusionAdolescents with T1D may be at a higher risk of poor glycemic control if they have poor QoL, impaired family functioning, poor coping skills, and lower socioeconomic status, suggesting that psychosocial interventions could potentially improve glycemic control in this population.


2007 ◽  
Vol 5 (1) ◽  
Author(s):  
Maartje de Wit ◽  
Henriette A Delemarre-van de Waal ◽  
Jan Alle Bokma ◽  
Krijn Haasnoot ◽  
Mieke C Houdijk ◽  
...  

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