This program of research addresses psychological/health status relationships in children with insulin dependent diabetes mellitus. Psychological variables that should have a direct bearing on the child's health were selected for initial study. A causal model was developed in which patient and parent knowledge about diabetes, patient and parent attitudes toward diabetes, and parental supervision of the child were presumed to relate to adherence with the diabetes regimen, and adherence, in turn, was presumed to relate to diabetes control. Although adherence was predicted reasonably well by the model, the link between adherence and diabetes control proved problematic. In a series of cross-sectional and longitudinal investigations, few significant associations between adherence and diabetes control emerged. When significant associations did occur, they were weak in magnitude and/or highly complex, involving interactions with other variables (e.g., patient age, disease duration, diabetes control at the study's inception). The proposed application explores adherence/diabetes control linkages further using a longitudinal research design with adolescents who have had the disease for 3 years or more. The disease duration requirement was selected to eliminate variability due to endogenous insulin replacement in youngsters more recently diagnosed. The longitudinal design was selected to permit measurement of change in the model constructs selected for study. Adolescents are of particular interest because they are less adherent and are in worse diabetes control than their younger counterparts. Yet, prior causal models have failed to identify strong, consistent and significant paths between adolescents' adherence behaviors and their diabetes control. Maturational changes associated with puberty may exert a negative influence on diabetes control during this developmental period; this hypothesis will be tested in the research proposed. Once these biological changes are statistically modelled, adherence/diabetes control relationships may be more readily discerned. However, it is also possible that our prior conceptualization of adherence is faulty. To address this issue, four different conceptualizaions of adherence will be compared. Similarly, measures of diabetes control have been expanded in an effort to tap adherence/diabetes control linkages in a more sensitive manner. Finally, this application proposes to examine both main effects of adherence, pubertal status, and insulin dose and to explore possible interactions between adherence and the other model constructs, as predictors of diabetes control.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD013820-12
Application #
3312355
Study Section
Behavioral Medicine Study Section (BEM)
Project Start
1980-12-01
Project End
1994-12-31
Budget Start
1993-07-01
Budget End
1994-06-30
Support Year
12
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of Florida
Department
Type
Schools of Medicine
DUNS #
073130411
City
Gainesville
State
FL
Country
United States
Zip Code
32611
Meltzer, Lisa J; Johnson, Suzanne Bennett; Pappachan, Sarah et al. (2003) Blood glucose estimations in adolescents with type 1 diabetes: predictors of accuracy and error. J Pediatr Psychol 28:203-11
Johnson, Suzanne Bennett; Meltzer, Lisa J (2002) Disentangling the effects of current age, onset age, and disease duration: parent and child attitudes toward diabetes as an exemplar. J Pediatr Psychol 27:77-86
Meltzer, L J; Johnson, S B; Prine, J M et al. (2001) Disordered eating, body mass, and glycemic control in adolescents with type 1 diabetes. Diabetes Care 24:678-82
Johnson, S B; Perwien, A R; Silverstein, J H (2000) Response to hypo- and hyperglycemia in adolescents with type I diabetes. J Pediatr Psychol 25:171-8
Tercyak Jr, K P; Johnson, S B; Kirkpatrick, K A et al. (1998) Offering a randomized trial of intensive therapy for IDDM to adolescents. Reasons for refusal, patient characteristics, and recruiter effects. Diabetes Care 21:213-5
Johnson, S B (1994) Health behavior and health status: concepts, methods, and applications. J Pediatr Psychol 19:129-41
Johnson, S B (1992) Methodological issues in diabetes research. Measuring adherence. Diabetes Care 15:1658-67
Johnson, S B; Kelly, M; Henretta, J C et al. (1992) A longitudinal analysis of adherence and health status in childhood diabetes. J Pediatr Psychol 17:537-53
Johnson, S B (1991) Methodological considerations in pediatric behavioral research: measurement. J Dev Behav Pediatr 12:361-9
Nurick, M A; Johnson, S B (1991) Enhancing blood glucose awareness in adolescents and young adults with IDDM. Diabetes Care 14:1-7

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