Patterns of self-management in pediatric type 1 diabetes predict level of glycemic control 2 years later

Abstract

Objective: To determine if 3 distinct self-management patterns (i.e., maladaptive, moderate/mixed, and adaptive) observed at baseline, 1 year, and 2 years in a sample of youth with type 1 diabetes and their caregivers predicted mean differences in adolescent's subsequent glycemic control.

Methods: This study is a descriptive, multisite, prospective study that examined a sample of youth diagnosed with type 1 diabetes (ages 9-11 years at baseline). Youth and their maternal and paternal caregivers provided information about the youth's self-management patterns at baseline, 1 year, and 2 years using the Diabetes Self-Management Profile structured interview. Glycemic control (hemoglobin A1c: HbA1c) was examined at baseline and 6, 12, 18, and 24 months.

Results: Three distinct self-management patterns were observed at 1 year and 2 years, which were conceptually consistent with previously reported baseline self-management patterns. Youth identified by their maternal caregivers as having adaptive self-management patterns at baseline had better glycemic control across 2 years compared with those in the maladaptive and mixed self-management groups. Similarly, maternal reports suggested that youth with less adaptive self-management patterns generally had worse glycemic control over time and HbA1c values above the American Diabetes Association recommendations. Youth and paternal caregiver reports yielded more variable findings.

Conclusions: Findings underscore the stability of self-management patterns in pediatric type 1 diabetes and the need for preventive interventions that are tailored to specific patterns of self-management associated with risk for problematic glycemic control.

Figure 1

Maternal Reports of Self-Management Patterns at Baseline: Relationship to Clinically Relevant Differences in Glycemic Control from six to 24 months. Note: Within range = mean HbA1c value of youth whose HbA1c was below ADA recommendations at that timepoint; Above range = mean HbA1c value of youth whose HbA1c was above ADA recommendations at that timepoint; Percentages are the percentage of youth included in this category;* = Group differences observed (p < 0.05) between within range and above range comparisons at that time point.

Figure 2

Maternal Reports of Changes in Self-Management Patterns from Baseline to Two Years: Relationship to Clinically Relevant Differences in Glycemic Control. Note: Within range = mean HbA1c value of youth whose HbA1c was below ADA recommendations at that timepoint; Above range = mean HbA1c value of youth whose HbA1c was above ADA recommendations at that timepoint; Percentages are the percentage of youth included in this category; * = Group differences observed (p < 0.05) between within range and above range comparisons at that time point.