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Journal of Pediatric Psychology Advance Access originally published online on March 16, 2005
Journal of Pediatric Psychology 2006 31(10):1036-1045; doi:10.1093/jpepsy/jsj017
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© The Author 2005. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oupjournals.org

Self-Care Autonomy and Outcomes of Intensive Therapy or Usual Care in Youth with Type 1 Diabetes

Tim Wysocki, PhD, ABPP1, Michael A. Harris, PhD2, Lisa M. Buckloh, PhD1, Karen Wilkinson, BSN, CDE1, Michelle Sadler, BSN, CDE2, Nelly Mauras, MD1 and Neil H. White, MD, CDE2

1 Nemours Children’s Clinic and, 2 Washington University School of Medicine

All correspondence concerning this article should be addressed to Tim Wysocki, Center for Pediatric Psychology Research, Nemours Children’s Clinic, 807 Children’s Way, Jacksonville, Florida 32207. E-mail: twysocki{at}nemours.org.

Objective This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA1C) in 142 youths with diabetes. Methods Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Results Higher baseline AMR was associated with higher baseline HbA1C for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Conclusion Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.

Key words: adolescents; children; intensive therapy; type 1 diabetes.


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