Diabetes Self-Management Profile Research Articles

Family conflict: Risk factor for low adherence in adolescents with type 1 diabetes in Greek families

Introduction: Type 1 Diabetes Melitus (T1DM) treatment is demanding, due to daily blood glucose monitoring, certain diet plan, specific exercise program, multiple daily insulin injections, and management of episodes of hypo- or hyperglycemia. Family conflict may play a significant role in the adherence of adolescents with type 1 diabetes. Purpose: To evaluate Greek families’ conflicts and determine their relationship with T1DM adolescents’ adherence. Methods: A cross-sectional study was conducted from October 2021 to June 2022. Due to COVID-19 restriction, all the interviews were conducted through online survey. Three questionnaires were distributed to the adolescents. Pediatric Quality of Life Inventory tool, Diabetes Self-Management Profile and Collaborative Parent Involvement Scale for Youths Questionnaire. PeDsQL was distributed to their parents as well. Results: 59 adolescents (N=21) aged 10-19 years and their parents (N=38) participated. The mean values of PedsQL for all five factors ranged from 55.7 (Worry subcategory) to 77.8 (Treatment adherence), showing an overall moderate QoL. According to the mean values, parents’ perspectives PedsQL for all five factors ranged from 38.6 (Worry subcategory) to 77 (Treatment adherence), showing an overall moderate QoL. Mean DSMP score indicated a high level of adherence of children with diabetes mellitus to their treatment, whilst mean cooperation score indicated a high level of cooperation between parents and adolescents with T1DM and low level of FC. Bivariate analysis revealed that less FC was related to better treatment adherence in adolescents. Conclusions: T1DM management remains challenging, particularly as children grow older and move into adolescence. The family can play a significant role in T1DM management. Diabetes multidisciplinary teams should evaluate and understand family members' interactions detecting inter-family problems such as high frequency of FC. Provision of family support can improve communication between adolescents and parents and may reduce FC resulting in better T1DM treatment adherence and outcomes.

The effect of problem-solving skills on blood glucose regulation and disease management in children with type 1 diabetes mellitus.

This cross-sectional study examined the relationship between problem-solving skills, glucose regulation, and disease management in children with type 1 diabetes mellitus (T1DM) as well as the role of depression in this association. The participants (n=54) were recruited from adiabetes camp. Problem-solving inventory (PSI), Beck depression inventory (BDI), and diabetes self-management profile (DSMP) were administered as tests. Forty-six participants who have been diagnosed with T1DM for at least a year and completed the survey were included in the analyses. Participants were categorized into high and low depression groups based on the median split. Student's t-test was used to detect demographic differences in groups. Linear regression models were used to examine the association between PSI, HbA1c, and DSMP. Regressions for PSI and DSMP were repeated in low and high-depression groups. Of the 46 participants with T1DM, 52 % were female, with a mean age of 13.96 ± 1.94 (range 10-17). Avoidant and monitoring style of problem solving as well as the total score of PSI significantly predicted HbA1c levels. Impulsive and avoidant style of problem solving, problem-solving confidence, and total scores of PSI significantly predicted DSMP (p<0.05). The high depression group had a significantly higher DSMP score than the low depression group (p=0.001), with no difference in HbA1c levels (p=0.968). When the DSMP regressions were repeated, no significant associations were seen in the low depression group. Avoidant style of problem solving, problem-solving confidence, and the total score of PSI significantly predicted DSMP in the high depression group (p<0.005). Problem solving-skills are essential in children with T1DM for a successful disease management. Depression modulates the association between the problem-solving and self-management profile.

Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial.

The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).

Efficacy of the Flexible Lifestyles Empowering Change intervention on metabolic and psychosocial outcomes in adolescents with type 1 diabetes (FLEX): a randomised controlled trial

Adolescents with type 1 diabetes commonly have poor glycaemic control. We aimed to test the efficacy of a newly developed adaptive behavioral intervention (Flexible Lifestyles Empowering Change; FLEX) on metabolic and psychosocial outcomes in adolescents with type 1 diabetes. Young people (13-16 years, type 1 diabetes duration >1 year, HbA1c of 64-119 mmol/mol [8·0-13·0%], and without other serious medical conditions or pregnancy) from two clinical sites (Colorado and Ohio, USA) were eligible for enrolment. One caregiver was required to participate actively in the study. Adolescent participants were randomly assigned to the FLEX intervention, which used motivational interviewing and problem-solving skills training to enhance patients' self-management, or usual care control. Intervention fidelity was assessed by a behavioral psychologist with specific expertise in motivational interviewing and who was not otherwise involved in the study via audiotaped sessions. The primary outcome was measurement of glycated haemoglobin A1c (HbA1c) at 18 months. Secondary outcomes included motivation and intention, problem solving skills, self-management behaviors, symptoms of depression, health related quality of life, fear of hypoglycemia, diabetes family conflict, risk factors for T1D complications (BMI, blood pressure, and plasma lipids), and hypoglycemia derived from continuous glucose monitoring (percent time below 3·0 and 3·9 mmol/l [54 and 70 mg/dl]). Intention-to-treat analyses used mixed effects models, with fixed effects including site, timepoint, intervention group, intervention by timepoint, and baseline level of primary (HbA1c) or secondary outcomes (α=0·05). FLEX is registered on clinicaltrials.gov, number NCT01286350. Young people recruited from May 1, 2014 to April 4, 2016 were randomly assigned to FLEX (n=130) or usual care control (n=128). Mean diabetes duration was 6·4 (SD 3·8) years, and 71% (181 out of 256) of patients used insulin pump therapy. Retention was 93%, with 241 out of 258 completing the 18-month assessment. The intervention fidelity score was 4·40 of 5·00 for motivational interviewing and 97% for session content. At 18 months, HbA1c was not significantly different between intervention (83 [13] mmol/mol at baseline; 84 [19] mmol/mol at follow-up); and control (80 [14] mmol/mol at baseline; 82 [17] mmol/mol at follow-up); change in intervention versus control was -0·7 mmol/mol (95% CI -4·7 to 3·4, p=0·75). The intervention was associated with improved scores for motivation (p=0·011), problem solving (p=0·024), diabetes self-management profile (p=0·013), youth report of overall quality of life (p=0·0089), selected domains related to fear of hypoglycaemia (p=0·036 for youth's helplessness or worry; p=0·0051 for parent's efforts to maintain high blood glucose), parent report of diabetes family conflict (p=0·0001), total cholesterol (p=0·038), and diastolic blood pressure (p=0·015). A total of 54 serious adverse events were identified; 34 of these were diabetes-related, including low blood glucose requiring assistance (n=3) and high blood glucose with diabetic ketoacidosis and emergency response (n=25). The FLEX intervention did not significantly change HbA1c among these adolescents with elevated HbA1c, but did positively affect several psychosocial outcomes over 18 months. Further analyses will provide information regarding drivers of positive response to the intervention and will point to future directions for improvement in the approach. National Institutes of Health and National Institute of Diabetes Digestive Diseases and Kidney and the Helmsley Charitable Trust.

The Flexible Lifestyles Empowering Change (FLEX) Intervention Trial for Adolescents with Type 1 Diabetes—Primary and Secondary Outcomes

Youth with T1D often have poor glycemic control and compromised health and well-being. Our aim was to test the efficacy of the FLEX adaptive behavioral intervention on the primary (HbA1c) and secondary (psychosocial and metabolic) outcomes at 18 months. Youth (n=258) aged 13-16 years, diagnosed &amp;gt;1 year with T1D with HbA1c from 8.0-13.0%, were randomized at two sites to FLEX or usual care control. Mean (sd) duration of diabetes was 6.4 (3.8) years, 50% were girls, 78% non-Hispanic white, mean HbA1c was 9.6% (1.2) and 71% used insulin pump therapy. FLEX used motivational interviewing and problem-solving skills training to enhance self-management. Intervention fidelity was assessed via random selection of audiotaped sessions for counseling strategy and session content. Intent-to-treat analyses used mixed effects models, with fixed effects of site, timepoint, intervention group, intervention by timepoint and baseline level of primary or secondary outcomes, with a random intercept (alpha=0.05). Retention was 97%, with intervention fidelity 4.6 out of 5 for counseling strategy and 97.4% complete for session content. HbA1c was not statistically significantly different between intervention and control at 18 months. Among secondary outcomes at 18 months, the intervention was associated with improved scores for symptoms of depression (p=0.04), quality of life (p=0.01), motivation (p=0.009), problem-solving (p=0.04), and diabetes self-management profile (p=0.01), as well as better total cholesterol (p=0.04), and better diastolic blood pressure (p=0.01). The FLEX intervention did not change the primary outcome, but did positively effect psychosocial outcomes over the 18 months of the trial. Further analyses will reveal information regarding drivers of positive response to the intervention and will point to directions for improvement in the approach, perhaps incorporating more specific direction towards achievement of glycemic targets. Disclosure E.J. Mayer-Davis: None. F.K. Bishop: None. K.A. Driscoll: None. C.M. Hunter: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. M. Seid: None. D. Standiford: None. J. Thomas: None.

Dental, periodontal and salivary conditions in diabetic children associated with metabolic control variables and nutritional plan adherence.

Diabetes mellitus is a chronic disease that has manifestations other than alterations in endocrine regulation or in metabolic pathways. Several diseases of the oral cavity have been associated with diabetes mellitus type 1 and 2 in young people according to their evolution. Scarce information exists regarding the role of diabetes and its association with the oral health status in paediatric diabetic patients. The aims of the study were to assess the quality of saliva, saliva acidogenicity, dental caries experience, fluorosis and periodontal status in diabetic patients and to evaluate their relationship with metabolic control variables and nutritional plan adherence. The study population consisted of 60 paediatric patients with both types of diabetes mellitus. Saliva testing included stimulated flow, pH (using pH indicator strips), buffer capacity and Snyder's Test. DMFT/dmft and dental caries experience were determined on the basis of ICDAS II codes. The periodontal status was assessed by PI and GI and fluorosis by FI. Nutritional plan adherence was established from the subscale "Dietary Control" of the Diabetes Self-Management Profile questionnaire. Medical Data was retrieved from the clinical registers in the Diabetic Clinic. We describe the main characteristics of the oral cavity related variables of our population that might guide the clinical practice in similar settings; we found a dmft/DMFT of 1.71 ± 1.74 and 0.64 ± 1.03, PI of 1.91 ± 0.75, GI of 0.50 ± 0.56 and a fluorosis prevalence of 61%. We identified several correlated variables, which indicate strong associations between the nutritional habits of the patients and co-occurrence of oral cavity physiopathological alterations. Several correlations were found between acidogenic activity of the saliva (Snyder Test) and the percentage of adherence to the nutritional plan and to the dmft index. Furthermore, a significant correlation between the buffering capacity of the saliva and the glycemic control of the participants was found. Neither an association nor a difference among means was found between treatment regime and the plaque index. The results of the present study concluded that there was a significant relationship between diabetes mellitus and an increased prevalence of oral cavity related diseases in the paediatric population. These are also associated with a poor adherence to the nutritional plan.

Translation and validation of diabetes self-management profile (DSMP) into Brazilian Portuguese language: first instrument to assess type 1 diabetes self-management in a pediatric population

ObjectiveTo translate and validate the instrument Diabetes Self-Management Profile (DSMP)—Conventional and Flexible Regimens into Brazilian Portuguese language in order to evaluate the quality of diabetes self-management in children and adolescents with type 1 diabetes and their caregivers.MethodsDSMP was submitted to forward and back translation method and validated in a group of type 1 diabetes youths between 6 and 18 years (n = 102), and their families. Analysis of DSMP internal consistency, intra and interobserver reliability and concurrent correlation with HbA1c were done.ResultsDSMP total scores demonstrated adequate internal consistency (Cronbach’s α = 0.79), 3-month test–retest reliability (ρ = 0.53; p < 0.001), inter-interviewer agreement (ρ = 0.55; p < 0.001). DSMP total score was significantly correlated to HbA1c (ρ = −0.54, p < 0.001).ConclusionDSMP-translated version is a reliable and valid tool to assess diabetes self-management.

Cross-cultural adaptation and psychometric tests of a self-efficacy scale and an adherence scale for French adolescents with Type 1 diabetes

Introduction : many structured educational programs, using the concept of self-efficacy, have been studied in English-speaking countries. Background : tools were developed in English to assess this concept along with treatment adherence. However, there seems to be no French version of these tools in scientific literature. Aim : to adapt the tools to the French language and to test the psychometric properties of the Self-Efficacy for Diabetes Self-Management (SEDM) and the Diabetes Self-Management Profile (DSMP). Methods : a cross-cultural adaptation of the SEDM and DSMP in French was performed. The psychometric properties were tested in a pilot study that took place between January 1st and December 31st, 2015. Results : Cronbach’s alpha coefficient of SEDM in French was 0.84, test-retest reliability 0.80 and sensitivity to change was moderate. The Cronbach’s alpha and sensitivity to change of the French DSMP were low, and the test-retest was 0.71. Discussion and conclusions : the first results of the psychometric properties of French SEDM were rather encouraging. The use of the French version of DSMP seems compromised in terms of psychometric properties and the opinion of the participants.

Impact of a Serious Videogame Designed for Flexible Insulin Therapy on the Knowledge and Behaviors of Children with Type 1 Diabetes: The LUDIDIAB Pilot Study

Flexible (or functional) insulin therapy method is a self-management education approach for intensive insulin therapy in patients with type 1 diabetes. The serious game (or applied game) "L'Affaire Birman" ("Mr. Birman's File") (available at www.gluciweb.com ) was specifically designed as an educational tool for the flexible insulin therapy method. Its educational impact was evaluated in children with type 1 diabetes. This prospective multicenter pilot study evaluated the effect of this videogame on the therapeutic knowledge and behavior of children with type 1 diabetes. PedCarbQuiz (PCQ) and Diabetes Self-Management Profile (DSMP) questionnaires were used before (T0), immediately after (T1), and 6 months after (T2) the unstructured use of the videogame. The 38 children enrolled in the study were 42% boys and 58% girls; they had a mean age of 13.7 ± 2.1 years old, a diabetes duration of 6.0 ± 3.8 years, and hemoglobin A1c (HbA1c) levels of 8.5 ± 1.4% (69.4 ± 9.4 mmol/mol). The children connected to the game 3.3 ± 2.8 times during this 6-month study. Their PCQ score increased from 31.6 ± 4.9 at T0 to 36.0 ± 4.0 at T2 (P < 0.05). Two PCQ subscores also increased significantly: the insulin titration score at T1 and T2 and the carbohydrate quantification score at T2. Conversely, the DSMP score was not different at T0, T1, and T2 (59.1 ± 9.9, 60.2 ± 9.8, and 60.0 ± 10.0, respectively), and HbA1c levels also remained stable throughout the study (8.4 ± 1.3%, 8.4 ± 1.2%, and 8.5 ± 1.5% at T0, T1, and T2, respectively). Subgroup analysis found a greater impact of the game in children with poor glycemic control and low knowledge at baseline. Adherence to the game was rather low (half of the children played less than 2.5 bouts), but no criterion was found to be predictive of this low attractiveness. Nonsupervised usage of the serious game "L'Affaire Birman" was able to improve insulin titration and carbohydrate quantification in children with type 1 diabetes.

Cross-cultural adaptation and validation to Brazilian Portuguese of two measuring adherence instruments for patients with type 1 diabetes.

BackgroundThe purpose of this study was to carry out a cross-cultural adaptation to Brazilian Portuguese, validation, and comparison of two questionnaires to measure adherence in patients with type 1 diabetes. There are no validated instruments to measure treatment adherence in Brazilian patients with type 1 diabetes.MethodsType 1 diabetes outpatients of a tertiary hospital in Southern Brazil were recruited to examine psychometric properties of the Diabetes Self-Management Profile (DSMP) and Self-Care Inventory-revised (SCI-R) adapted to Brazilian Portuguese. Analyses assessed the reliability and validity according to its associations with glycated hemoglobin (A1C). Seventy-five patients [age: 34.9 ± 13.7 years; A1C: 9.2 ± 2% (75 mmol/mol); diabetes duration: 18.1 ± 11.8 years] were evaluated.ResultsThe translated versions of the instruments showed adequate internal consistency (DSMP Cronbach’s α =0.76; SCI-R Cronbach’s α =0.71). A positive correlation was found between all the items and total scores, except for item 12 in DSMP and item 13 in SCI-R, and for this reason, these items were excluded from the translated versions. In predictive validity analysis, A1C correlated significantly with the DSMP total (r = −0.46) and with the SCI-R total (r = −0.44).ConclusionsThe Brazilian Portuguese versions of DSMP and SCI-R yielded a reliable and valid tool to measure adherence treatment for patients with type 1 diabetes, with a significant correlation between total scores and A1C.

The Diabetes Related Executive Functioning Scale (DREFS): Pilot Results

The assessment of youth executive functioning (EF) associated with diabetes management has been difficult to accomplish, yet is important to optimizing adherence. To improve EF assessment, we developed the Diabetes Related Executive Functioning Scale (DREFS) and piloted its administration to 50 youth with type 1 diabetes and their caregivers. Youth/caregiver dyads completed analogous versions of the DREFS, Behavioral Rating Inventory of Executive Functioning (BRIEF), and the Self-Administered Diabetes Self-Management Profile (SA-DSMP). HbA1c assays were used as an index of glycemic control. Caregiver and youth DREFS scores were associated with BRIEF, SA-DSMP totals, and HbA1c.

Self-Management, Health Service Use and Information Seeking for Diabetes Care among Black Caribbean Immigrants in Toronto

The objective of this research was to explore self-management practices and the use of diabetes information and care among Black-Caribbean immigrants with type 2 diabetes. The study population included Black-Caribbean immigrants and Canadian-born participants between the ages of 35 to 64 years with type 2 diabetes. Study participants were recruited from community health centres (CHCs), diabetes education centres, hospital-based diabetes clinics, the Canadian Diabetes Association and immigrant-serving organizations. A structured questionnaire was used to collect demographics and information related to diabetes status, self-management practices and the use of diabetes information and care. Interviews were conducted with 48 Black-Caribbean immigrants and 54 Canadian-born participants with type 2 diabetes. Black-Caribbean immigrants were significantly more likely than the Canadian-born group to engage in recommended diabetes self-management practices (i.e. reduced fat diet, reduced carbohydrate diet, non-smoking and regular physical activity) and receive regular A1C and eye screening by a health professional. Black-Caribbean immigrant participants were significantly more likely to report receiving diabetes information and care through a community health centre (CHC) and nurses and dieticians than their Canadian-born counterparts. CHCs and allied health professionals play an important role in the management of diabetes in the Black-Caribbean immigrant community and may contribute to this group's favourable diabetes self-management profile and access to information and care. Additional research is necessary to confirm whether these findings are generalizable to the Black-Caribbean community in general (i.e. immigrant and non-immigrant) and to determine whether the use of CHCs and/or allied health professionals is associated with favourable outcomes in the Black-Caribbean immigrant community as well as others.

Patterns of Self-Management in Pediatric Type 1 Diabetes Predict Level of Glycemic Control 2 Years Later

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. 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. 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. 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.

Changes in Executive Functioning and Self-Management in Adolescents With Type 1 Diabetes: A Growth Curve Analysis

To investigate the relation of changes in executive functioning to changes in diabetes self-management in a 2-year prospective study of a sample of youth aged 9-11 years at baseline (n = 239) with type 1 diabetes and their maternal caregivers. Youth and maternal caregivers completed the Diabetes Self-Management Profile (DSMP) at baseline, 12 months, and 24 months. Maternal caregivers completed the Behavioral Rating Inventory of Executive Functioning (BRIEF) at the same time points to assess global executive functioning, and the domains of behavioral regulation and metacognition. Youth reported self-management decreased over time (p < .01) while behavioral regulation (e.g., the child's ability to shift cognitive set and moderate emotions and behaviors via emotional control) increased (p < .05). Changes in behavioral regulation significantly predicted rate of change in youth-reported self-management (p < .01). Global executive functioning and metacognition (e.g., the child's ability to monitor, initiate, plan, organize, and sustain future-oriented problem solving and working memory) did not change over time and did not predict changes in self-management. Moreover, executive functioning and self-management did not predict changes in HbA1c. Positive changes in behavioral regulation may enhance self-management of type 1 diabetes during the transition to adolescence.

Diabetes Self-Management Profile Short Form: A Preliminary Report

Effective family management of type 1 diabetes in childhood is critical to maintaining optimal glycemic control. The purpose of this study was to provide preliminary evidence for a reduced form of the Diabetes Self-Management Profile (DSMP) using Rasch modeling techniques. The study was a secondary analysis of DSMP data drawn from a previous study on patterns of self-management from 239 preadolescents with type 1 diabetes. Rasch modeling strategies were used to identify the most informative items and then a reduced score composite was correlated with hemoglobin A1c (A1c) and blood glucose monitoring (BGM) frequency. A short form of the DSMP was obtained using seven items that comprised all five subscales of the DSMP. The DSMP Short-Form (DSMP-SF) composite score correlated significantly with child's HbA1c and BGM frequency. The DSMP-SF may be considered a valid and effective screening interview alternative to the longer, original, DSMP, particularly when attempting to identify high-risk patients.

Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model

The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N=226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9-11years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1year later (p<0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.

Validation of a self-report version of the diabetes self-management profile

Inadequate treatment adherence impedes achievement of glycemic control targets in type 1 diabetes (T1D). Valid and reliable measurement of treatment adherence is a prerequisite to rigorous evaluation of pertinent interventions. The diabetes self-management profile (DSMP), a structured interview measure of T1D adherence, is valid and reliable but it requires trained interviewers, it is labor intensive to administer and it is burdensome for research participants. We adapted the DSMP interview to create the DSMP-self-report questionnaire (DSMP-SR) for completion by parents and youth ≥11 yr old. The DSMP-SR was obtained during a cross-sectional study of 151 youth within the age range of 8 to <18 yr with T1D [male, 50.7%; racial minorities, 23%; mean age, 13.9 yr; T1D duration, 5.5 yr; hemoglobin A1c (HbA1c), 8.7%] and a parent of each. Parents and youth ≥11 yr old completed the DSMP-SR independently. The DSMP-SR had sound internal consistency (Cronbach's α: youth, 0.82; parent, 0.80), and parent-youth agreement, (r = 0.60, p < 0.001) and significant associations with HbA1c (r = -0.35 for youth and -0.46 for parents, p < 0.001), PedsQL quality of life scale (youth: r = -0.41, p < 0.001; parent: r = -0.40, p < 0.001) and, for parents but not youth, the Revised Diabetes Family Conflict Scale (r = -0.47, p < 0.001). Higher DSMP-SR scores were associated with lower HbA1c, better quality of life, and less family conflict. The DSMP-SR has similar psychometric properties to those reported elsewhere for the DSMP, yielding a convenient measure of T1D adherence.

Validation of an abbreviated adherence measure for young people with Type 1 diabetes

Adherence to diabetes-related tasks is an important construct. The Diabetes Self-Management Profile is a validated, semi-structured interview assessing adherence in paediatric patients with Type 1 diabetes. We created and validated a brief questionnaire version of the Diabetes Self-Management Profile called the Diabetes Self-Management Questionnaire. Young people with Type 1 diabetes, ages 9-15 years (n = 338) and their parents provided data from chart review, interview and questionnaires. Diabetes Self-Management Questionnaire scores correlated significantly with Diabetes Self-Management Profile scores, HbA(1c) , blood glucose monitoring frequency and other measures associated with adherence and/or glycaemic control (P ≤ 0.01 for all). Young people and parent scores were correlated (r = 0.55, P < 0.0001). The Diabetes Self-Management Questionnaire demonstrated modest internal consistency (Cronbach's α = 0.59), adequate for a brief measure of multidimensional adherence. In addition, factor analysis confirmed one factor. This brief adherence questionnaire demonstrated construct validity in young people 9-15 years old and their parents and may have utility in clinical and research settings.

Identification of self-management patterns in pediatric type 1 diabetes using cluster analysis

This study identified three distinct patterns of self-management groups for a sample of 239 youth (9-11 years) with type 1 diabetes and their maternal and paternal caregivers, and assessed their relationship to glycemic control (HbA1c). Youth and their maternal and paternal caregivers were administered the diabetes self-management profile (DSMP) to assess self-management. Glycemic control was based on hemoglobin A1c. Two-step cluster analysis identified three different self-management groups based on youth, maternal, and paternal reports. Analysis of variance indicated that the pattern of less optimal diabetes self-management was associated with worse glycemic control. Our results objectively describe differences in patterns of self-management in youth with type 1 diabetes, that relate to glycemic control. Interventions based on these specific patterns of self-management may improve diabetes management and enhance glycemic control in children and adolescents with type 1 diabetes.

Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes

The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients. Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison. On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.