Glycemic Control, Coping, and Internalizing and Externalizing Symptoms in Adolescents with Type 1 Diabetes: A Cross-Lagged Longitudinal Approach

  1. Sarah E. Hampson, Ph.D.(3)
  1. 1. Catholic University Leuven, Leuven, Belgium
  2. 2. University of Mainz, Mainz, Germany
  3. 3. Oregon Research Institute, Eugene, Oregon
  4. 4. The first author is a Postdoctoral Researcher at the Fund for Scientific Research Flanders, (FWO).


Objective: The present study set out to examine how active coping and withdrawal, psychological (internalizing and externalizing) symptoms, and glycemic control (A1C-values) influenced each other across time in adolescents with type 1 diabetes.

Research Design and Methods: 109 adolescents participated in a four-wave longitudinal study spanning four years (mean age at Time 1 was 13.77). Patients were visited at home and completed questionnaires measuring coping and psychological symptoms. The treating physicians were contacted to obtain A1C-values. Cross-lagged path analysis from a structural equation modeling approach was used for data-analysis.

Results: Clinically meaningful pathways between coping and glycemic control were found across time. Active coping prospectively predicted lower A1C-levels which, in turn, predicted active coping. Higher A1C-levels and higher psychological symptoms consistently predicted avoidant coping across time. Finally, psychological symptomatology constituted an important link in the observed longitudinal chain of effects. More specifically, higher A1C-values and symptomatology at Time 1 positively predicted withdrawal at Time 2 which, in turn, positively predicted symptomatology at Time 3. Next, symptomatology at Time 3 positively predicted higher A1C-values at Time 4, coming full circle.

Conclusions: Coping with everyday stress, psychological symptoms, and glycemic control were interrelated across time. Evidence was obtained for reciprocal pathways and mutually reinforcing mechanisms, indicating the need to monitor coping strategies and psychological symptoms, besides glycemic control, in optimizing clinical care in adolescents with type 1 diabetes.


    • Received October 30, 2010.
    • Accepted March 13, 2010.

This Article

  1. Diabetes Care
  1. All Versions of this Article:
    1. dc09-2017v1
    2. 33/7/1424 most recent