Longitudinal Trajectories of Metabolic Control Across Adolescence: Associations With Parental Involvement, Adolescents' Psychosocial Maturity, and Health Care Utilization

• Published in: Journal of adolescent health 2012-05, Vol.50 (5), p.491-496
• Main Authors: King, Pamela S., Ph.D, Berg, Cynthia A., Ph.D, Butner, Jonathan, Ph.D, Drew, Linda M., Ph. D, Foster, Carol, M.D, Donaldson, David, M.D, Murray, Mary, M.D, Swinyard, Michael, M.D, Wiebe, Deborah J., Ph.D., M.P.H
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Development; Adolescents; Biological and medical sciences; Child; Diabetes Mellitus, Type 1 - metabolism; Diabetes Mellitus, Type 1 - psychology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycemic control; hba1c; Health care utilization; Hospitalization; Humans; Latent class growth analysis; Longitudinal; Longitudinal Studies; Male; Maturity; Medical sciences; Metabolic control; Parent-Child Relations; Parental involvement; Parental participation; Parenting - psychology; Parents; Patient Compliance - psychology; Pediatrics; Psychology, Adolescent; Psychosocial factors; Psychosocial maturity; Self Care - psychology; Selfcontrol; Type 1 diabetes
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2011.09.007

Abstract Purpose To predict trajectories of metabolic control across adolescence from parental involvement and adolescent psychosocial maturity, and to link metabolic control trajectories to health care utilization. Methods Two hundred fifty-two adolescents (M age at study initiation = 12.5 years, SD = 1.5, range = 10–14 years) with type 1 diabetes (54.4% female, 92.8% Caucasian, length of diagnosis M = 4.7 years, SD = 3.0, range = 1–12 years) participated in a 2-year longitudinal study. Metabolic control was gathered from medical records every 3 months. Adolescents completed measures of self-reliance (functional autonomy and extreme peer orientation), self-control (self-control and externalizing behavior), and parental involvement in diabetes care (acceptance, monitoring, and frequency of help). At the end of the study, mothers reported health care utilization (diabetes-related emergency room visits and hospitalizations) over the past 6 months. Results Latent class growth analyses indicated two distinct trajectories of metabolic control across adolescence: moderate control with slight deterioration (92% of the sample; average HbA1c = 8.18%) and poor control with rapid deterioration (8% of the sample; average HbA1c of 12.09%). Adolescents with poor and rapidly deteriorating metabolic control reported lower paternal monitoring and frequency of help with diabetes management, lower functional autonomy, and lower self-control than others. Those with poor and rapidly deteriorating metabolic control were 6.4 times more likely to report diabetes-related emergency room visits, and 9.3 times more likely to report diabetes-related hospitalizations near the end of the study. Conclusions Parental involvement and adolescents' psychosocial maturity predict patterns of deteriorating metabolic control across adolescence and could be targeted for intervention.