Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic

• Published in: Journal of pediatric psychology 2022-08, Vol.47 (8), p.873-882
• Main Authors: Miller, Alison L, Albright, Dana, Bauer, Katherine W, Riley, Hurley O, Hilliard, Marisa E, Sturza, Julie, Kaciroti, Niko, Lo, Sharon L, Clark, Katy M, Lee, Joyce M, Fredericks, Emily M
• Format: Article
• Language: English
• Subjects: Adolescent; COVID-19; Diabetes Mellitus, Type 1 - psychology; Humans; Original; Pandemics; Protective Factors; Self-Control
• ISSN: 0146-8693; 1465-735X; 1465-735X
• DOI: 10.1093/jpepsy/jsac045

The COVID-19 pandemic increased economic, social, and health stressors for families, yet its impacts on families of youth with chronic conditions, such as type 1 diabetes (T1D), are not well understood. Self-regulation (SR)-or the capacities to control emotions, cognition, and behavior in response to challenge-is known to support T1D management and coping in the face of stress. Strong SR may have protected youth with T1D from the impacts of pandemic-related stressors. This study compared youth and parent emotional functioning and T1D management before and after the pandemic's onset in relation to family pandemic-related stress and youth SR. Parents of youth with T1D (N = 88) and a subset of these youth (N = 43; Mean age 15.3 years [SD 2.2]) completed surveys regarding SR, stress, emotional functioning, and T1D-related functioning prior to and after March 2020. Outcomes were compared using mixed effects models adjusting for covariates. Family pandemic-related stress experiences and youth SR were tested as moderators of change. Parents' responsibility for T1D management increased across pandemic onset and their diabetes-related distress decreased. Family pandemic-related stress was associated with decreased emotional functioning over time. Youth SR, particularly emotional and behavioral aspects, predicted better emotional and T1D-related functioning. While youth with T1D whose families experienced higher pandemic-related stress had poorer adjustment, strong emotional and behavioral SR appeared to protect against worsening youth mood and adherence across pandemic onset. Both social-contextual and individual factors are important to consider when working with families managing T1D.