This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.The prevalence of type 2 diabetes among children and adolescents is a growing problem (1) and is related to the increasing incidence of obesity and sedentary lifestyle in this age group. The primary task of the management of type 2 diabetes is to maintain a level of blood glucose that closely approximates normal levels. Acceptable management of the disease involves a complex balance of medication, diet and exercise and adherence to the recommended regimen is key to successful self-care. In children and adolescents specifically, management is a family affair, requiring some degree of parental monitoring and the opportunity for parent and child to interface around a stressful aspect of the child's life. For the child with type 2 diabetes, management adds another life context where issues related to independence and negotiation between parent and child are highlighted. The proposed study aims to provide longitudinal data regarding the relation between tasks of illness management and those normative tasks of the day-to-day life of an adolescent in a sample of adolescents with type 2 diabetes. We will examine two salient aspects of adolescents' lives, behavioral autonomy and the quality of the relationship between parent and child, within the two contexts of their lives, diabetes-related and normative. The relationships between these factors and diabetes-related outcomes including adherence to treatment regimen will be assessed.
Specific aims are: 1. To evaluate how behavioral autonomy (level of independent management or self-governance) and parent-child conflict relate to adherence to the type 2 diabetes treatment regimen. In this prospective study, do autonomy and/or conflict predict regimen adherence? 2. To evaluate the relationship of behavioral autonomy regarding normative tasks, (e.g., chores, schoolwork) to behavioral autonomy regarding type 2 diabetes management tasks (diet, exercise, blood glucose testing). 3. To evaluate the relationship of the quality of parent-adolescent negotiation about normative issues to the quality of parent-child negotiation about type 2 diabetes management tasks.Data will be collected from approximately 170 parent-adolescent dyads over a 1 year period from 8 sites that are participating in the TODAY trial, enrolling youth of differing ethnicities. Self-report measures of behavioral autonomy and parent-child conflict will be collected at baseline, 6 months and 12 months. ANOVA will be used to assess whether these scores predict adherence at follow-up, controlling for demographic factors such as age. Changes over time will also be examined. The results will help to inform the future development of appropriate interventions to improve regimen adherence, promote successful weight loss and decrease relational conflict in youth with type 2 diabetes and might include helping parents to develop more realistic expectations of their child regarding diabetes self-care.
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