Associations between major life events and adherence, glycemic control, and psychosocial characteristics in teens with type 1 diabetes
Persis V Commissariat, Lisa K Volkening, Zijing Guo, Jessica L ElBach, Deborah A Butler, Lori M Laffel, Persis V Commissariat, Lisa K Volkening, Zijing Guo, Jessica L ElBach, Deborah A Butler, Lori M Laffel
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](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5648628/bin/nihms875893f1.jpg)
![Figure 2a. Associations between teen-reported psychosocial characteristics…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5648628/bin/nihms875893f2.jpg)
Figure 2b. Associations between parent-reported psychosocial characteristics…
Figure 2b. Associations between parent-reported psychosocial characteristics and life events
Parents of teens who experienced…
- Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management.Ersig AL, Tsalikian E, Coffey J, Williams JK. Ersig AL, et al. J Pediatr Nurs. 2016 Jul-Aug;31(4):390-6. doi: 10.1016/j.pedn.2015.12.012. Epub 2016 Jan 29. J Pediatr Nurs. 2016. PMID: 26831378
- Understanding the Areas and Correlates of Diabetes-Related Distress in Parents of Teens With Type 1 Diabetes.Hessler D, Fisher L, Polonsky W, Johnson N. Hessler D, et al. J Pediatr Psychol. 2016 Aug;41(7):750-8. doi: 10.1093/jpepsy/jsw002. Epub 2016 Feb 10. J Pediatr Psychol. 2016. PMID: 26869664
- Problems With Self-Regulation, Family Conflict, and Glycemic Control in Adolescents Experiencing Challenges With Managing Type 1 Diabetes.Vaid E, Lansing AH, Stanger C. Vaid E, et al. J Pediatr Psychol. 2018 Jun 1;43(5):525-533. doi: 10.1093/jpepsy/jsx134. J Pediatr Psychol. 2018. PMID: 29077875 Free PMC article.
- Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry.Joiner KL, Holland ML, Grey M. Joiner KL, et al. J Nurs Scholarsh. 2018 Nov;50(6):676-686. doi: 10.1111/jnu.12428. Epub 2018 Sep 24. J Nurs Scholarsh. 2018. PMID: 30246919 Free PMC article.
- General quality of life in youth with type 1 diabetes: relationship to patient management and diabetes-specific family conflict.Laffel LM, Connell A, Vangsness L, Goebel-Fabbri A, Mansfield A, Anderson BJ. Laffel LM, et al. Diabetes Care. 2003 Nov;26(11):3067-73. doi: 10.2337/diacare.26.11.3067. Diabetes Care. 2003. PMID: 14578241
- Effects of Trauma and Anxiety on Adherence in Pediatric Type 1 Diabetes.Raj R, Nguyen M, Pozzo AM, Marsac ML, Vselvoshakaya O, Meadows AL. Raj R, et al. Diabetes Spectr. 2022 Spring;35(2):171-178. doi: 10.2337/ds21-0024. Epub 2021 Nov 29. Diabetes Spectr. 2022. PMID: 35668893 Free PMC article.
- Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review.Turin A, Drobnič Radobuljac M. Turin A, et al. World J Diabetes. 2021 Sep 15;12(9):1518-1529. doi: 10.4239/wjd.v12.i9.1518. World J Diabetes. 2021. PMID: 34630904 Free PMC article. Review.
- Blood glucose monitoring (BGM) still matters for many: Associations of BGM frequency and glycemic control in youth with type 1 diabetes.Ortiz La Banca R, Pirahanchi Y, Volkening LK, Guo Z, Cartaya J, Laffel LM. Ortiz La Banca R, et al. Prim Care Diabetes. 2021 Oct;15(5):832-836. doi: 10.1016/j.pcd.2021.05.006. Epub 2021 May 21. Prim Care Diabetes. 2021. PMID: 34031003 Free PMC article.
- Ready or not? Greater readiness for independent self-care predicts better self-management but not HbA1c in teens with type 1 diabetes.Goethals ER, Volkening LK, Tinsley L, Laffel LM. Goethals ER, et al. Diabet Med. 2021 May;38(5):e14507. doi: 10.1111/dme.14507. Epub 2021 Feb 17. Diabet Med. 2021. PMID: 33372275 Free PMC article.
- The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study.Hung LC, Huang CY, Lo FS, Cheng SF. Hung LC, et al. Int J Environ Res Public Health. 2020 Jul 16;17(14):5132. doi: 10.3390/ijerph17145132. Int J Environ Res Public Health. 2020. PMID: 32708617 Free PMC article.
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Adolescent
- Diabetes Mellitus, Type 1 / drug therapy
- Diabetes Mellitus, Type 1 / psychology*
- Female
- Humans
- Insulin Infusion Systems
- Life Change Events*
- Longitudinal Studies
- Male
- Medication Adherence / psychology*
- Medication Adherence / statistics & numerical data
- Parents
- Full Text Sources
- Other Literature Sources
- Medical
- Research Materials
![Figure 2b. Associations between parent-reported psychosocial characteristics…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5648628/bin/nihms875893f3.jpg)
Source: PubMed