Clinical and psychosocial factors associated with achievement of treatmentgoals in adolescents with diabetes mellitus

Purpose: To examine the following questions with regard to the initiation o f a new intensive management program for adolescents with Type 1 diabetes m ellitus: (a) What clinical and psychosocial factors are associated with ach ievement of metabolic control treatment goals after 1 year? and (b) What ba seline clinical and psychosocial factors are associated with improvement in the quality of life after 12 months? Methods: Eighty-one subjects (of 83 who began; aged 14.3 +/- 2.0 years at e ntry; 48 females, 33 males; 95% white; diabetes duration 8.9 +/- 3.9 years) with Type 1 diabetes completed 12 months of follow-up in a study of intens ified treatment of diabetes. Assessments at baseline and at 12 months used the Diabetes Quality of Life for Youth scale, the Self-efficacy for Diabete s Scale, the Children's Depression Inventory, the Issues in Coping with Dia betes Scale, and the Diabetes Family Behavior Scale. Data were analyzed usi ng multiple and logistic regression. Results: From a baseline of >9%, HbA1c levels decreased to a mean of 7.8 +/ - 0.7%, with 30% of the subjects achieving our treatment goal of less than or equal to7.2%. Logistic regression demonstrated that achievement of goal levels of HbA1c were associated with better metabolic control at study entr y (p = .05), participation in coping skills training (p = .003), and more p arental participation in guidance and control (p = .05). Multiple regressio n analysis demonstrated that participation in coping skills training with l ower impact of diabetes on quality of life at baseline and less depression at baseline contributed significantly to the variance (0.57) in quality of life at 12 months. Conclusions: Providers need to pay particular attention to adolescents with poorer metabolic control and impact of diabetes on quality of life when th ey intensify their treatment because they are less likely to reach treatmen t goals. Furthermore, behavioral interventions such as coping skills traini ng may help teens achieve their goals. (C) Society for Adolescent Medicine, 2001.