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

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• 作者：Pamela S. King ; Ph.D.^a ; ^{pam.king@psych.utah.edu} ; Cynthia A. Berg ; Ph.D.^a ; Jonathan Butner ; Ph.D.^a ; Linda M. Drew ; Ph. D.^b ; Carol Foster ; M.D.^a ; David Donaldson ; M.D.^a ; Mary Murray ; M.D.^a ; Michael Swinyard ; M.D.^c ; Deborah J. Wiebe ; Ph.D. ; M.P.H.^b
• 关键词：Type 1 diabetes ; Adolescents ; Metabolic control ; Glycemic control ; hba1c ; Health care utilization ; Hospitalization ; Longitudinal ; Latent class growth analysis ; Parental involvement ; Psychosocial maturity
• 刊名：Journal of Adolescent Health
• 出版年：2012
• 期刊代码：140_1054139x
• 类别：med
• 出版时间：May, 2012
• 卷：50
• 期：5
• 页码：491-496
• 文件大小：472 K

摘要

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.