Oscar Escobar

Predictors of Metabolic Control among Adolescents with Diabetes: A 4-Year Longitudinal Study

OBJECTIVE To employ a risk and resistance framework to examine changes in metabolic control over early to middle adolescence. METHODS We interviewed 70 girls and 62 boys (mean age 12 years) annually for 4 years. Risk and resistance factors, including demographics, disease-related variables, self-care behavior, and psychosocial variables were assessed. Hemoglobin A1c was obtained from medical records. RESULTS Multilevel modeling showed metabolic control deteriorated with age. Self-care behavior interacted with age to predict the decline, such that self-care was more strongly related to poor metabolic control for older adolescents. Eating disturbances, depression, and peer relations were related to poor metabolic control, whereas good family relations were related to better metabolic control for girls. CONCLUSIONS Independent risk factors for poor metabolic control included poor self-care, disturbed eating behavior, depression, and peer relations; parental support was an independent resistance factor for girls. Future research should examine mechanisms by which these relations emerge.

A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency

Helgeson VS, Honcharuk E, Becker D, Escobar O, Siminerio L. A focus on blood glucose monitoring: relation to glycemic control and determinants of frequency.

Diet of Adolescents With and Without Diabetes: Trading candy for potato chips?

OBJECTIVE—To compare the dietary intake of adolescents with type 1 diabetes with that of adolescents without diabetes matched on age, sex, and year in school and to compare the diets of both groups with recommendations. RESEARCH DESIGN AND METHODS—Participants were 132 adolescents with type 1 diabetes, recruited from Children’s Hospital of Pittsburgh, and 131 adolescents without diabetes ranging in age from 10.70 to 14.21 years. Dietary intake was assessed with three 24-h recall interviews with each participant and one parent. Percentage of calories from protein, carbohydrates, and total fat; amount of each type of fat; and amount of cholesterol, fiber, and sugar were calculated as averages across 3 days. RESULTS—Adolescents with diabetes took in less total energy than recommended. The percentage of calories from carbohydrates and protein were within recommendations for adolescents with and without diabetes, but adolescents with diabetes exceeded the recommended fat intake. The diet of adolescents with diabetes consisted of a greater percentage of fat and protein and a smaller percentage of carbohydrates relative to adolescents without diabetes. Adolescents without diabetes consumed more sugar, while adolescents with diabetes took in more of all components of fat than adolescents without diabetes. Male subjects with diabetes had an especially high intake of saturated fat. CONCLUSIONS—Adolescents with type 1 diabetes consume fewer calories from carbohydrates but more calories from fat than adolescents without diabetes and exceed the recommended levels of fat intake. These findings are of concern given the risk that type 1 diabetes poses for cardiovascular disease.

Brief Report: Trajectories of Glycemic Control over Early to Middle Adolescence

OBJECTIVES To identify distinct patterns of glycemic control over early to middle adolescence, and to determine whether psychosocial variables predicted those patterns. METHODS We used trajectory analysis to examine glycemic control over 5 years among adolescents with type 1 diabetes who were of age 12 on average at study start (n = 132). Well-being, relationships, and self-care behavior were assessed with in-person interviews. Blood glucose testing was determined from blood glucose meters, and missed clinic appointments and glycosolated hemoglobin were obtained from medical records. RESULTS We identified two distinct clusters of individuals, a stable good glycemic control group and a poorer deteriorating glycemic control group. Individuals in the deteriorating control group were characterized by higher peer conflict, more negative diabetes emotions, fewer blood glucose tests, and more missed clinic appointments. CONCLUSION Psychosocial variables and behavioral markers of self-care may predict the course of glycemic control over early to middle adolescence.

Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes

The goals of the study were to describe the transition of youth with Type 1 diabetes from paediatric to adult healthcare services, examine the link of this transition with self care and glycaemic control, and distinguish youth who received medical treatment from different physicians in terms of demographic and parent relationship variables.

Relation of Stressful Life Events to Metabolic Control Among Adolescents With Diabetes: 5-Year Longitudinal Study

OBJECTIVE To determine the relation of stressful life events to metabolic control. DESIGN We interviewed adolescents with Type 1 diabetes (n = 132; average age at enrollment = 12 years) annually for 5 years. MEASURES Each year we administered measures of stressful life events, psychological distress, and self-care behavior. We downloaded data from blood glucose meters, and obtained measures of metabolic control (hemoglobin A1c) from medical records. RESULTS Using longitudinal growth curve modeling, stressful life events predicted greater psychological distress, poorer self-care behavior, and worse metabolic control in both cross-sectional and longitudinal (lagged) analyses. Cross-sectionally, many of these relations were stronger among older than younger adolescents. Self-care behavior partly mediated this association. CONCLUSION Stressful life events are related to poor metabolic control-especially for older adolescents. A primary mechanism appears to be a lack of good self care. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Families With Children With Diabetes: Implications of Parent Stress for Parent and Child Health

OBJECTIVE To examine the relation of parent stress to parent mental health and child mental and physical health. METHODS We interviewed children with type 1 diabetes (n = 132; mean age 12 years) annually for 5 years and had one parent complete a questionnaire at each assessment. Parents completed measures of general life stress, stress related to caring for a child with diabetes, benefit finding, and mental health. Child outcomes were depressive symptoms, self-care behavior, and glycemic control. Multilevel modeling was used to examine concurrent and longitudinal relations. RESULTS Greater parent general stress and greater parent diabetes-specific stress were associated with poorer parent mental health. Overall, greater parent general stress was associated with poorer child outcomes, whereas greater parent diabetes-specific stress was associated with better child outcomes. CONCLUSIONS Families with high levels of general life stress should be identified as they are at risk for both poor parent and child health outcomes.

Emerging adults with type 1 diabetes: a comparison to peers without diabetes.

OBJECTIVE This longitudinal study compared emerging adults with and without type 1 diabetes on life path decisions, health behaviors, and psychological well-being during the transition out of high school. METHODS Administered questionnaires during the senior year of high school and 1 year later to 117 emerging adults with diabetes and 122 emerging adults without diabetes. Comparisons were conducted with respect to health status, sex, and school status. RESULTS Those with and without diabetes chose similar life paths and engaged in similar levels of risky behaviors, but disturbed sleep increased for males with diabetes only. Having diabetes was not associated with depressive symptoms, loneliness, or bulimic symptoms, but was associated with lower life satisfaction and lower life purpose over time. CONCLUSIONS Emerging adults with and without diabetes fare similarly on most dimensions studied during the first year out of high school.

Relationships and health among emerging adults with and without Type 1 diabetes.

OBJECTIVE The studys goal was to examine the impact of parent and peer relationships on health behaviors and psychological well-being of those with and without Type 1 diabetes over the transition to emerging adulthood. Emerging adulthood is an understudied developmental period and a high-risk period--especially for those with Type 1 diabetes. METHOD Youth with (n = 117) and without Type 1 diabetes (n = 122) completed questionnaires during their senior year of high school and 1 year later. Measures included supportive and problematic aspects of parent and peer relationships, health behaviors, psychological well-being, and, for those with diabetes, self-care behavior and glycemic control. RESULTS Prospective multiple and logistic regression analysis revealed that friend conflict was a more potent predictor than friend support of changes in health behaviors and psychological well-being. Parent support was associated with positive changes in psychological well-being and decreases in smoking, whereas parent control was related to increases in smoking and depressive symptoms. There was some evidence of cross-domain buffering such that supportive relationships in one domain buffered adverse effects of problematic relationships in the other domain on health outcomes. CONCLUSIONS This longitudinal study showed that parent relationships remain an important influence on, and peer relationships continue to influence, the health behaviors and psychological well-being of emerging adults with and without Type 1 diabetes. Parent relationships also have the potential to buffer the adverse effects of difficulties with peers.

Unmitigated Communion and Health Among Adolescents With and Without Diabetes The Mediating Role of Eating Disturbances

The authors examined the implications of unmitigated communion—a focus on others to the exclusion of the self—for psychological and physical health among adolescents with (n = 132) and without (n = 131) diabetes times / during a 1-year period. Unmitigated communion predicted greater psychological distress and lower levels of competence cross-sectionally and longitudinally, controlling for sex, pubertal status, and communion. Health status moderated some longitudinal relations, such that relations held only for adolescents with diabetes. In addition, unmitigated communion was associated with poor metabolic control and predicted a deterioration in metabolic control over the year for adolescents with diabetes. Unmitigated communion also was associated with disturbed eating behavior cross-sectionally and longitudinally, and disturbed eating behavior explained some of the relations of unmitigated communion to psychological but not physical health outcomes.