Personal models of diabetes in relation to self-care, well-being, and glycemic control - A prospective study in adolescence

OBJECTIVE - Personal models of diabetes have been shown to be proximal dete rminants of self-care behavior in adults with diabetes, both cross-sectiona lly and prospectively. This study set out to Lest the predictive utility of this approach in adolescents with diabetes. RESEARCH DESIGN AND METHODS - Participants were recruited from four regiona l hospitals in southern England (n = 54). They completed questionnaires ass essing diabetes self-caret well-being, and personal models of diabetes (per ceived impact, perceived seriousness, and short- and long-term treatment ef fectiveness) at baseline and 1-year follow-up. GHb assays performed as part of the patients' usual diabetes care were used to assess glycemic control. RESULTS - After controlling for baseline anxiety. change in perceived impac t of diabetes prospectively predicted adolescents' anxiety (beta = -0.21; t = -2.65, P < 0.01). After controlling For baseline dietary self-care, chan ge in perceived effectiveness of the diabetes treatment regimen to control diabetes predicted dietary self-care (<beta> = -0.39; t = -3.28; P < 0.0005 ). Poorer dietary self-care and being female were predictive of poorer glyc emic control (r(2) = 0.29; F = 2.74; P < 0.005). CONCLUSIONS - This study provides further support for the role of personal models of illness in determining responses to illness. As adolescents take responsibility for the management of their diabetes, parents, clinicians, e ducators, and interventionists should consider these adolescents' beliefs a bout their diabetes and its treatment as key factors influencing self-care, emotional well-bring, and glycemic control.