Personality variables and metabolic control in children with diabetes

Insulin-dependent diabetic children and a group of their nondiabetic peers were compared on measures of self-concept, locus of control and health locus of control. A metabolic measure of long term diabetes control was also obtained on the children with diabetes. Data analyses revealed that metabolic control was not related to any of the personality measures in the diabetic sample. Diabetic and non-diabetic children did not differ on measures of locus of control and self-concept, but diabetics exhibited a health locus of control which was significantly more internal than that of control subjects. A possible explanation for these results was discussed and practical implications for health care providers working with young diabetics were presented.     

Ethnic differences in illness perceptions,self-efficacy and diabetes self-care

This study assessed differences between Europeans, South Asians and Pacific Islanders in illness perceptions, self-efficacy, self-care, metabolic control and retinopathy in diabetes. We also evaluated the role of illness perceptions and self-efficacy in diabetes self-care and metabolic control within each group. A total of 86 Europeans, 86 South Asians, and 87 Pacific Islanders with type-2 diabetes completed self-report measures of illness perceptions, self-efficacy and self-care. Metabolic control and retinopathy data were collected from patient records. Results showed that Pacific Islanders and South Asians held shorter illness timeline perceptions compared to Europeans. Relative to both the other groups, Pacific Islanders also had elevated scores on three illness perceptions subscales: consequences, identity and emotional representations. They had lower medication-specific self-efficacy as well as poorer medication self-care, metabolic control and retinopathy. In all three groups, self-efficacy was fairly consistently related to self-care, but not to metabolic control. Illness perceptions were less consistently related to self-care, but were associated with metabolic control.     

Diabetes, depression, and metabolic control in Latinas

Diabetes is steadily becoming an epidemic among Latinos, and depression has been found to complicate diabetes management. This study examined depressive symptoms and metabolic control in Latinas with diabetes in a community clinic setting. The association of depressive symptoms with metabolic control was supported in this study. Social support (but not acculturation) was found to be associated with depressive symptoms. Finally, age and metabolic control were related. These findings are explained in a culture-specific framework. The authors speculate that the role of the woman in Latino families makes it difficult for a Latina to attend to her own care needs until she ages.     

Child's and parents' catastrophizing about pain is associated with procedural fear in children: a study in children with diabetes and their mothers

The contribution of the child's and parents' catastrophizing about pain was explored in explaining procedural pain and fear in children. Procedural fear and pain were investigated in 44 children with Type I diabetes undergoing a finger prick. The relationships between parents' catastrophizing and parents' own fear and estimates of their child's pain were also investigated. The children and their mothers completed questionnaires prior to a routine consultation with the diabetes physician. Children completed a situation-specific measure of the Pain Catastrophizing Scale for Children (PCS-C) and provided ratings of their experienced pain and fear on a 0-10 numerical rating scale (NRS). Parents completed a situation-specific measure of the Pain Catastrophizing Scale For Parents (PCS-P) d provided estimates of their child's pain and their own experienced fear on a 0-10 NRS. Analyses indicated that higher catastrophizing by children was associated with more fear and pain during the finger prick. Scores for parents' catastrophzing about their children's pain were positively related to parents' scores for their own fear, estimates of their children's pain, and child-reported fear, but not the amount of pain reported by the child. The findings attest to the importance of assessing for and targeting child and parents' catastrophizing about pain. Addressing catastrophizing and related fears and concerns of both parents and children may be necessary to assure appropriate self-management. Further investigation of the mechanisms relating catastrophizing to deleterious outcomes is warranted.     

Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents with Type 1 Diabetes in Poor Metabolic Control: A Pilot Investigation

The purpose of the current study was to conduct a pilot investigation to determine the effectiveness of Multisystemic Therapy (MST) for improving regimen adherence and metabolic control among adolescents with poorly controlled Type 1 diabetes. Thirty-one adolescents were randomly assigned to either MST or a control condition. MST treatment lasted approximately six months. Data were collected at study entry and at a six-month posttest. Twenty-five adolescents completed the study. Adolescents who received MST had significantly improved adherence to blood glucose testing and metabolic control from study entry to the six-month posttest, whereas controls did not. Adolescents receiving MST also had a decreased number of inpatient admissions at the six-month posttest. Improvements in metabolic control were related to improvements in parent report of adolescent adherence. Results suggest that MST holds promise as an intervention for improving adherence behavior and health outcomes among adolescents in poor metabolic control.     

Neuropsychological complications of insulin dependent diabetes in children

Previous research suggests that children with insulin dependent diabetes (IDDM) show selective impairments on neuropsychological tests, with those developing IDDM before 5 years of age appearing to be the most affected. The effect of hypoglycaemia on the developing brain has been suggested as a possible risk factor as has the disruptive effect of chronic hyperglycaemia on myelinisation. A cohort of children (n = 124) with newly diagnosed IDDM, managed at The Royal Children's Hospital, Melbourne has been assembled and evaluated 3 months post diagnosis on standardised tests of general intelligence, attention, memory, new learning, executive functions, and educational achievement. The performance of the children with IDDM has been compared with that of a demographically representative control group (n = 129) of healthy children. At this baseline assessment, the findings strongly support the hypothesis that the neuropsychological and educational profiles of newly diagnosed children are not different from that of controls early in the course of the illness. Both groups will be reassessed 2 and 5 years after the initial evaluation when it is hypothesised that children with diabetes will perform more poorly. Parameters of the illness, such as age of onset, major metabolic crises, and history of glycaemic control will be related to the test performance of the children with IDDM to identify specific risk factors for neuropsychological and educational sequelae in that population.     

A projective measure for the concept of locus of control

The construction and validation of a projective type I-E Scale was devised to measure locus of control. This scale was designed specially to suit the age and culture of a population of school-going children in Sri Lanka. Results indicate that the general feeling of being in control of one's circumstances rather than that of being controlled by outside factors is related to the attitudes one brings to bear on academic achievement and on other achievement related situations. In addition, there was an overall tendency among these subjects towards greater internality. This was interpreted to support the concept of the moral value and the efficacy of effort and hard work.     

Psychosocial adjustment to and control of diabetes mellitus: differences by disease type and treatment

The relationship of diabetic patients' psychosocial adjustment to disease type, treatment mode, and indexes of control was examined in a representative community population. The psychometric properties of the Diabetes Educational Profile (DEP) and its application to psychosocial research in diabetes were also investigated. Findings support the reliability and validity of the DEP. Various measures of psychosocial adjustment were related to diabetes control but the specific relationships depended on the particular aspect of adjustment, the specific measure of diabetes control, and the type of disease and treatment. The findings suggest that analyses that aggregate dissimilar patient groups are subject to misinterpretation due to ecological masking and supressor effects. The results indicate that clinicians and researchers must recognize that patients with different disease types and treatment modes have different norms for psychological adjustment and diabetes control. Further, the particular aspects of psychosocial adjustment associated with diabetes control differ across patient groups.     

Glycosylated hemoglobin and psychological adjustment in adolescents with diabetes

The relationships between glycosylated hemoglobin levels as an index of metabolic control, life events occurring in the previous year, and general adjustment in the areas of attitude towards diabetes, independence, peer, school, and family relationships were investigated in 37 adolescents with insulin-dependent diabetes mellitus. The number or type of life events did not show a relationship with metabolic control. As measured by the Sullivan Diabetic Adjustment Scale, diabetic adolescents who were in better metabolic control reported more conflict regarding family relationships and issues of independence than did those in lesser control.     

A Contextual Model of Control Beliefs,Behavior, and Health: Latino and European Americans with Type 2 Diabetes

Sense of control is frequently found to be related to health. A model of control beliefs, disease-management behaviors, and health indicators was tested in a sample of 74 Latino Americans and 115 European Americans with Type 2 diabetes. Two measures of control beliefs, one diabetes-specific (diabetes self-efficacy) and one global (mastery), were examined for their effects on management behaviors (diet and exercise) and on health (Hb_A1C and general health). Results indicated that the relationship between control and management behaviors varied by measure of control and by group. For Latino participants, global mastery was related to management behaviors; whereas, self-efficacy was related to such behaviors among European Americans. The relationship between control and health did not appear to be mediated by management behaviors. This study provides support for a diversified approach to control, behavior, and health.     

Individual Growth Curve Modeling of Specific Risk Factors and Memory in Youth with Type 1 Diabetes: An Accelerated Longitudinal Design

Objective: To examine if diabetes risk factors disrupt memory score trajectories in youth with T1D over three years with a powerful accelerated longitudinal method and individual growth curve modeling. Methods: Participants aged 9–17 completed memory measures at study enrollment and two years later. Results: Poorer metabolic control over the course of the study related to a significant decrease in visual memory scores. Compared to baseline, these youth scored 1.99 points lower at follow-up. Generally appropriate developmental gains were made in memory trajectories and girls' visual and verbal memory improved more than boys. No significant effects of disease duration, age of onset, or severe hypoglycemia were found on visual or verbal memory over three years time. Conclusions: Of the risk factors studied, only poorer metabolic control had a significant impact upon visual memory after three years. Verbal memory was unaffected. However, given that level of metabolic control tends to remain relatively consistent over time, the effect of continued poorer metabolic control on memory should be monitored.     

The relationship of diabetes knowledge to regimen compliance and metabolic control during pregnancy

Abstract

The relationship of diabetes knowledge to regimen compliance and metabolic control was examined in a sample of pregnant women with preexisting insulin-dependent and noninsulin-dependent diabetes mellitus (N = 27) and women who developed gestational diabetes during pregnancy (N = 45). Subjects completed self-report measures of diabetes knowledge and compliance with their diabetic regimen and blood glucose levels were monitored. Knowledge was positively, although modestly, related to dietary compliance, compliance with insulin administration and insulin reaction management recommendations, as well as fasting blood glucose levels. Findings suggest that among pregnant women, efforts to increase knowledge of diabetes specific to pregnancy may result in some improvement in selected aspects of the diabetic regimen.     

Development of the Diabetes Education, Counseling, Information Delivery and Evaluation (DECIDE) Program: A Health Promotion Intervention For Preadolescents with Type 1 Diabetes

Careful attention to self-care behaviors is crucial to achieving good health outcomes in children and adolescents with type 1 diabetes. Despite the unequivocal research findings that adolescence is a time of poor metabolic control among affected individuals, there have been few prevention efforts geared toward health promotion in this age group. The diabetes education, counseling and information delivery, and evaluation (DECIDE) Program is intended to prevent the deterioration of self-care behaviors often evident during adolescence by intervening during the earlier, more stable time period of preadolescence. This paper describes the foundation for the DECIDE Program and outlines intervention development, current study recruitment, and preliminary program evaluation data. Findings indicate that enrollment into the program is feasible among children and their parents; early feedback suggests that parents and children are also satisfied with their participation. The challenges of conducting randomized controlled trials in health promotion for childhood diabetes are discussed, and ideas are offered for future research directions to improve the integration of child health psychology with public health approaches in this population.     

Illness perceptions and self efficacy beliefs in adolescents and young adults with insulin dependent diabetes mellitus

Abstract

The study examined the role of illness perceptions and self-efficacy in diabetic regimen adherence and metabolic control among young patients with Insulin Dependent Diabetes Mellitus (IDDM). Sixty-four outpatients with Insulin Dependent Diabetes completed measures of illness perceptions, generalised and diabetes specific self-efficacy and a self-report measure of adherence. Metabolic control (HbAlc) was also assessed. Control, identity and consequences components of illness perceptions were significantly correlated with self-efficacy expectancies. Control beliefs were consistently associated with self-reported adherence across all treatment aspects and accounted for 39% of the predicted variance in total adherence. The associations of the other psychological predictors examined, varied depending on the regimen area. Multiple regression analysis showed that 30.8% of the variance in HbAlc assays was explained by patients' diabetes specific self-efficacy, consequences and identity. Our findings suggest that patients' beliefs are useful predictors of physiological and behavioural outcomes in diabetes self-management and should thus be the focus of routine clinical assessments and future interventions.     

Metabolic control and auditory information processing at altered glucose levels in insulin-dependent diabetes

Previous work with a visual reaction time (RT) paradigm showed rate of mental processing to be slowed during a state of brain energy depletion (i.e., hypoglycemia). The present study employed an analog auditory RT paradigm to determine if modality differences in processing information might occur in response to glucose alteration. A balanced crossover design was used in which men with insulin-dependent diabetes completed RT tasks of increasing complexity at each of the following glucose levels: hypoglycemia (60 mg/dL), normoglycemia/control (110 mg/dL), and hyperglycemia (300 mg/dL). Results revealed two performance groups. A convergent group displayed slower RT responding during hypoglycemia, consistent with the visual RT pattern of results. A divergent group displayed better responding on one RT measure during hypoglycemia, and generally poorer responding on all RT measures during the other glucose conditions. Subjects in the divergent group maintained more stringent metabolic control and tended to have experienced more episodes of hypoglycemic unconsciousness. The present results provide the first evidence that more stringent metabolic control may be related to generally slower rates of processing auditory information. Possible explanations for these findings include hypotheses of immutable structual derangement, state-dependent performance effects, and a U-shaped response curve.     

Psychometric properties of the Chinese version of the diabetes empowerment scale

Metabolic control is central to positive clinical outcome in patients with diabetes. Empowerment has been linked to metabolic control in this clinical group. The current study sought to determine key psychometric properties of the Chinese version of the Diabetes Empowerment Scale (C-DES) and to explore the relationship of the C-DES sub-scales to metabolic control in 189 patients with a diagnosis of diabetes. Confirmatory factor analysis established that the five sub-scales of the C-DES offered a highly satisfactory fit to the data. Furthermore, C-DES sub-scales were found to have generally acceptable internal consistency and divergent reliability. However, convergent reliability of C-DES sub-scales could not be established against metabolic control. It is concluded that future research needs to address ambiguities in the relationship between empowerment and metabolic control in order to afford patients an evidenced-based treatment package to assure optimal metabolic control.     

The Diabetes Family Behavior Checklist: A Psychometric Evaluation

The Diabetes Family Behavior Checklist (DFBC) assesses supportive and non-supportive parental behavior specific to diabetes management via parent and child reports. The DFBC was administered to 133 children with type 1 diabetes (T1D) and their caregivers. Subsequent analysis verified the two-factor structure of the DFBC corresponding to positive and negative support behaviors. Internal consistency was high for DFBC scores. Moderate to strong correlations with other measures of diabetes-specific familial behaviors, adherence, and metabolic control support the validity of the DFBC. Clinical application of the DFBC is discussed.     

Predictors of Diabetes Self‐care,Metabolic Control,and Mental Health in Youth with Type 1 Diabetes

The purpose of this study was to explore the psychosocial predictors of diabetes self‐care (adherence to care regimes), metabolic control (glycated haemoglobin), and mental health among rural‐ and urban‐dwelling youth with type 1 diabetes. One hundred and twenty three adolescents/young adults (aged 13?25 years, mean = 16 years, standard deviation = 3.8 years) with type 1 diabetes, 50 males and 73 females, completed questionnaires reporting on diabetes self‐care, metabolic control, mental health (negative affect, quality of life), risk‐taking behaviours and attitudes, diabetes self‐efficacy, community engagement, and perceived social support. No rural/urban differences were detected on key predictors or outcome variables. Structural equation modelling revealed that high diabetes self‐efficacy, lower risk behaviour, and more conservative attitudes to risk taking predicted better diabetes self‐care, which in turn predicted better metabolic control and mental health. Social support and engagement in community activities did not influence diabetes self‐care. The study has significance because both diabetes self‐efficacy and propensity towards risk behaviour are potential targets for educational and counselling interventions designed to improve diabetes self‐care regimes and resultant metabolic and mental health outcomes.     

The health belief model and adolescents with insulin-dependent diabetes mellitus.

We tested the predictive utility of the health belief model (HBM) for adherence with a complex, ongoing medical regimen in the context of a chronically ill youthful population (56 adolescent outpatients with insulin-dependent diabetes mellitus; mean age = 14 years). A three-construct model of health beliefs was tested: Threat (perceived susceptibility combined with severity), Benefits-Costs, and Cues to seek treatment. Multiple indicators of compliance were used, and metabolic control was measured by glycosylated hemoglobin. The Benefits-Costs and Cues constructs were related to compliance in the theoretically expected positive direction. Threat interacted with Benefits-Costs in the prediction of compliance and with Cues in the prediction of metabolic control. The greatest compliance was achieved with low perceived Threat and high perceived Benefits-Costs. Poor metabolic control was associated with high Threat and Cues. As age increased, adherence to the exercise, injection, and frequency components of the regimen decreased.