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Journal of Pediatric Psychology Advance Access published online on February 23, 2008
Journal of Pediatric Psychology, doi:10.1093/jpepsy/jsn012
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© The Author 2008. 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

Glycemic Control in Youth with Type 1 Diabetes: Family Predictors and Mediators

Danny C. Duke, MS1,2, Gary R. Geffken, PhD1,2,3, Adam B. Lewin, PhD4, Laura B. Williams, PhD5, Eric A. Storch, PhD2,3 and Janet H. Silverstein, MD3

1Department of Clinical and Health Psychology, 2Department of Psychiatry, 3Department of Pediatrics, University of Florida, 4Semel Neuropsychiatric Institute, University of California, and 5Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center

All correspondence concerning this article should be addressed to Gary R. Geffken, PhD, Department of Clinical and Health Psychology, University of Florida, PO Box 100165, 101 S. Newell Drive No. 3151, FL, USA. E-mail: geffken{at}ufl.edu


  Abstract

Objective This study examined predictive and mediated relationships among youth perception of critical parenting, Child Behavior Checklist Externalizing Subscale (CBCL) externalizing problem scores, adherence, and (hemoglobin A1c HbA1c), in youth with type 1 diabetes from low socioeconomic status families. Methods Caregiver/youth dyads (n = 120) completed diabetes specific measures of family functioning regarding diabetes management and structured adherence interviews. Parents completed the CBCL, while assays of youth HbA1c were performed. Analyses were conducted using hierarchical linear regression. Results Combined measures predicted 44% of the variance in HbA1c. Adherence partially mediated critical parenting and HbA1c, while critical parenting and adherence mediated CBCL externalizing problem scores and HbA1c. CBCL externalizing problem scores did not mediate critical parenting and HbA1c. Conclusions The presence of youth perceptions of critical parenting and youth externalizing behavior problems may interfere with adherence, leading to increases in HbA1c.

Key words: adherence; chronic illness; endocrinology; externalizing; family functioning; glycemic control; HbA1c; parents; type 1 diabetes..

Received April 17, 2007; revision received January 29, 2008; accepted February 4, 2008


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