Diabetes Self-Management Decrements Mediate the Relation of Stressful Life Events and Hemoglobin A1c-Differences by Race/Ethnicity in Adolescents

Giesje Nefs; Maggie R Albright-Pierce; Karin Kanc; Richard Feinn; Julie Wagner

doi:10.1016/j.jadohealth.2020.02.003

Diabetes Self-Management Decrements Mediate the Relation of Stressful Life Events and Hemoglobin A1c-Differences by Race/Ethnicity in Adolescents

J Adolesc Health. 2020 Aug;67(2):282-285. doi: 10.1016/j.jadohealth.2020.02.003. Epub 2020 Apr 4.

Authors

Giesje Nefs¹, Maggie R Albright-Pierce², Karin Kanc³, Richard Feinn⁴, Julie Wagner⁵

Affiliations

¹ Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults With Type 1 Diabetes, Rotterdam, The Netherlands. Electronic address: Giesje.Nefs@radboudumc.nl.
² Department of Psychology, Central Connecticut State University, New Britain, Connecticut.
³ jazindiabetes (Diabetes&Me), Private Diabetes Centre, Ljubljana, Slovenia.
⁴ Medical Sciences, School of Medicine, Quinnipiac University, Hamden, Connecticut.
⁵ Department of Behavioral Sciences and Community Health, University of Connecticut Schools of Medicine and Dental Medicine, Farmington, Connecticut.

PMID: 32265085
DOI: 10.1016/j.jadohealth.2020.02.003

Abstract

Purpose: The aim of the study was to establish whether suboptimal self-management explains the relationship between stressful life events and hemoglobin A1c (HbA_1c) in adolescents with type 1 diabetes and whether these relationships differ across race/ethnicity.

Methods: Participants were 6,368 adolescents enrolled in the U.S. T1D Exchange registry. The outcome, HbA_1c, was chart-based; predictors and covariates were self-reported. Moderated mediation was tested using Mplus, adjusting for gender, age, insulin treatment modality, and socioeconomic status.

Results: Higher frequency of missed insulin doses and lower frequency of daily self-monitoring of blood glucose partially explained the relationship between past-year stressful life events and higher HbA_1c. Mediation by self-monitoring of blood glucose was detected for those who identified as white non-Hispanic and Hispanic, but not for those who identified as African American.

Conclusions: In adolescents, there is some evidence for a behavioral mechanism in the stressor-HbA_1c relationship. African American youth may be more resilient against some detrimental behavioral effects of stressors.

Keywords: Diabetes self-management behaviors; HbA(1c); Race/ethnicity; Socioeconomic status; Stressful life events; T1D Exchange; Type 1 diabetes.

MeSH terms

Adolescent
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 1* / drug therapy
Ethnicity
Glycated Hemoglobin / analysis
Humans
Self-Management*

Substances

Blood Glucose
Glycated Hemoglobin A