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Journal of Pediatric Psychology Advance Access originally published online on October 12, 2005
Journal of Pediatric Psychology 2006 31(8):770-784; doi:10.1093/jpepsy/jsj083
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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@oxfordjournals.org

Predictors of Youth Diabetes Care Behaviors and Metabolic Control: A Structural Equation Modeling Approach

Clarissa S. Holmes, PhD1,2, Rusan Chen, PhD2, Randi Streisand, PhD3, Donna E. Marschall, PhD3, Sari Souter, PhD1, Erika E. Swift, PhD2 and Catherine C. Peterson, PhD4

1 Department of Psychology, Virginia Commonwealth University, 2 Department of Psychiatry, Georgetown University, 3 Department of Psychology, Children’s National Medical Center, and 4 Department of Psychology, Case Western Reserve University

All correspondence concerning this article should be addressed to Clarissa S. Holmes, PhD, Department of Psychology, Pediatrics, and Psychiatry PO Box 842018, Virginia Commonwealth University, Richmond, VA 23284-2018. E mail: cholmes{at}richmond.edu.

Received March 4, 2004; revisions received July 19, 2004 and September 1, 2005; accepted September 12, 2005

Objective To empirically test a biopsychosocial model of predictors of youth diabetes care behaviors and metabolic control. Methods A cross-sectional multisite study of youths (N = 222) with T1D (mean age = 12.6) used structural equation modeling to examine interrelations among predictors, with follow-up analyses of covariance (ANCOVAs). Results Youths’ memory skills related to diabetes knowledge which, along with self-efficacy and age, was associated with greater youth responsibility that in turn predicted poorer self-care behaviors. Less frequent/briefer exercise and less frequent blood glucose monitoring/eating were found; the latter directly related to poorer metabolic control. Behavior problems also were associated directly with poorer metabolic control. A parsimonious model found memory directly related to blood glucose testing. Conclusions Continued parental supervision of adolescents, along with monitoring diabetes knowledge and efficacy, may help optimize transfer of diabetes care from parents to youths. Behavior problems warrant immediate attention because of their direct and adverse relation to metabolic control.

Key words: diabetes; self-care; metabolic control.


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