Associations between major life events and adherence, glycemic control, and psychosocial characteristics in teens with type 1 diabetes

Abstract

Aims: This cross-sectional study assessed the type of major life events occurring in a contemporary sample of teens with type 1 diabetes and the association between event frequency and demographic, diabetes management, and psychosocial characteristics.

Methods: Parents of 178 teens completed the Life Events Checklist to report major events teens had experienced in the last year: 42% experienced 0 to 1 event (n = 75), 32% experienced 2 to 3 events (n = 57), and 26% experienced 4+ events (n = 46). Teens and parents completed validated measures of treatment adherence, diabetes-specific self-efficacy, quality of life, and diabetes-specific family conflict. Parent-youth interview and chart review provided demographics and diabetes management data.

Results: Mean number of events/teen was 2.6 ± 2.7 (range = 0-15). The most common events were "Hospitalization of a family member" (24%), "Getting a bad report card" (20%), "Serious arguments between parents" (19%), and "Serious illness/injury in a family member" (19%). Compared with teens experiencing 0 to 1 event, teens experiencing 4+ events were less likely to have married parents (P = .01) and a parent with a college degree (P = .006). Teens with 4+ events had significantly poorer adherence (P = .002 teen, P = .02 parent), lower self-efficacy (P = .03 teen, P < .0001 parent), poorer quality of life (P < .0001 teen, P < .0001 parent), and more conflict (P = .006 teen, P = .02 parent) than teens with fewer events. In a multivariate model (R 2 = 0.21, P < .0001) controlling for demographic and diabetes management characteristics, fewer events was associated with lower A1c (P = .0009).

Conclusions: Occurrence of more major life events was associated with poorer diabetes care and A1c and more negative psychosocial qualities in teens with type 1 diabetes.

Keywords: adolescent; hemoglobin A1c; life change events; patient adherence; type 1 diabetes mellitus.

Conflict of interest statement

CONFLICTS OF INTEREST

L.M.L. reports participation as a consultant for AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Eli Lilly and Company, Johnson & Johnson, Novo Nordisk Inc., Roche Diagnostics, and Sanofi.

P.V.C., L.K.V., Z.G., J.L.E., and D.A.B. report no potential conflicts of interest.

© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

Figure 1. Distribution of life event frequencies

Frequencies ranged from 0–15 events, with the most commonly endorsed number of life events being 0 or 1 event. 42% of teens (n=75) experienced 0–1 life event (yellow bars), 32% of teens (n=57) experienced 2–3 life events (blue bars), and 26% of teens (n=46) experienced 4 or more life events (black bars).

Figure 2a. Associations between teen-reported psychosocial characteristics and life events

Teens who experienced more life events reported significantly lower treatment adherence (p=0.002), self-efficacy (p=0.03), and quality of life (p

Figure 2b. Associations between parent-reported psychosocial characteristics and life events

Parents of teens who experienced more life events reported significantly lower treatment adherence (p=0.02), teen self-efficacy (p