Abstract
OBJECTIVE: To test the mediational effect of self-management behaviors (SMB) on the relationship between diabetes distress (DD) and glycemic levels in adolescents with type 1 diabetes (T1D). METHODS: We conducted a 3-year longitudinal, multisite study of 172 adolescents (M age = 16 years) with T1D recruited at three university medical centers. Blood samples were obtained yearly and analyzed for HbA1c in a central laboratory. The Problem Areas in Diabetes-Teen (PAID-T) scale was completed by youth, and the Diabetes Self-Management Profile (DSMP) was completed by youth and caregivers at baseline, 12, 24, and 36 months. RESULTS: There were significant negative cross-sectional correlations of PAID-T with adolescent and caregiver-reported SMB, as well as between HbA1c and adolescent and caregiver-reported SMB at the first three time points. There were significant positive cross-sectional correlations of HbA1c with PAID-T at all time points. Longitudinal correlations were in the expected directions, with 82.5% statistically significant. Results confirmed the mediating role of adolescent-reported SMB between DD and HbA1c at baseline, 12, and 36 months; caregiver-reported SMB mediated only at baseline. Significant sex differences were observed across all time points on the PAID-T, with females scoring higher in DD. CONCLUSIONS: The mediational models indicate that higher levels of DD were associated with increased HbA1c through lower SMB according to both adolescents and caregivers, although further study is needed in boys and girls, separately. Adolescents with high distress would likely benefit from support for effective SMB to ensure optimal glycemic levels.