Changes in Treatment Adherence and Glycemic Control During the Transition to Adolescence in Type 1 Diabetes

  1. Dennis Drotar, PHD1,4
  1. 1Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  2. 2Department of Pediatrics, University of Miami, Miami, Florida
  3. 3Division of Behavioral Health, Alfred I. duPont Hospital for Children, Wilmington, Delaware
  4. 4Department of Psychology, University of Cincinnati, Cincinnati, Ohio
  5. 5Division of Pediatric Endocrinology, Alfred I. duPont Hospital for Children, Wilmington, Delaware
  6. 6Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  1. Corresponding author: Dennis Drotar, dennis.drotar{at}cchmc.org.

Abstract

OBJECTIVE To test models of unidirectional and bidirectional change between treatment adherence and glycemic control in youth with type 1 diabetes.

RESEARCH DESIGN AND METHODS We conducted a 2-year longitudinal, multisite study of 225 youth with type 1 diabetes recruited at the cusp of adolescence (aged 9–11 years) to describe the mutual influences of glycemic control as measured by HbA1c and treatment adherence as measured by blood glucose monitoring frequency (BGMF) during the transition to adolescence.

RESULTS HbA1c increased from 8.2 to 8.6% (P < 0.001) and BGMF decreased from 4.9 to 4.5 checks per day (P < 0.02) during the 2-year period. Changes in the BGMF slope predicted changes in HbA1c. A change (increase) in HbA1c was associated with a change (decrease) in BGMF of 1.26 (P < 0.001) after controlling for covariates.

CONCLUSIONS The magnitude of the effect of declining treatment adherence (BGMF) on glycemic control in young adolescents may be even greater than declines observed among older adolescents. BGMF offers a powerful tool for targeted management of glycemic control for type 1 diabetes during the critical transition to adolescence.

  • Received November 7, 2011.
  • Accepted February 8, 2012.

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  1. Diabetes Care vol. 35 no. 6 1219-1224
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