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Metabolic Control in Adolescent Girls

Links to relationality and the female sense of self

¹ Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, Canada
² Division of Endocrinology, Hospital For Sick Children, Toronto, Canada

Address correspondence and reprint requests to Dr. S. Maharaj, Department of Psychiatry, Eaton Wing North, Toronto General Hospital, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4. E-mail: simaharaj{at}aol.com

OBJECTIVE—This study investigated whether intimacy and autonomy in mother-daughter interactions and relational aspects of the self are associated with metabolic control in adolescent girls with type 1 diabetes.

RESEARCH DESIGN AND METHODS—This cross-sectional study included 88 girls with diabetes (mean age 14.9 ± 2.2 years, diabetes duration 7.1 ± 3.9 years, and HbA_1c 8.9 ± 1.6%) from the Diabetes Clinic at the Hospital for Sick Children in Toronto and their mothers. Teens completed a self-report measure assessing self-concept in eight domain-specific areas. Mothers and daughters engaged in a 7-min, videotaped, problem-solving task involving a diabetes-related conflict issue. Interactions were rated using a macroanalytic rating system to assess intimacy and autonomy in parent-teen relationships. Metabolic control was measured using HbA_1c.

RESULTS—Self-concept in domains of perceived behavioral conduct (P = 0.003), social acceptance (P = 0.03), romantic appeal (P = 0.03), and close friendships (P = 0.04) independently predicted HbA_1c levels, together accounting for 30% of the variance. Also, the experience of emotional closeness (i.e., intimacy) rather than separateness (i.e., autonomy) in mother-daughter relationships was associated with lower HbA_1c (P = 0.03).

CONCLUSIONS—Relational aspects of the self and the experience of emotional closeness in relationships are associated with metabolic control in adolescent girls. Efforts to improve metabolic control in girls should include enhancing the self-concept and the experience of relatedness in familial, peer, and patient-caregiver relationships.

Abbreviations: AIRS, Autonomy and Intimacy Rating System • DCCT, Diabetes Control and Complications Trial • DSED-M, Diagnostic Survey for Eating Disorders–Modified • EDI, Eating Disorder Inventory • SPPA, Self-Perception Profile for Adolescents

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