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Pediatr Diabetes. 2018 Nov;19(7):1322-1330. doi: 10.1111/pedi.12713. Epub 2018 Jul 3.

Diabetes management mediating effects between diabetes symptoms and health-related quality of life in adolescents and young adults with type 1 diabetes.

Author information

1
Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas.
2
Department of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, Florida.
3
Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California.
4
Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Denver, Denver, Colorado.
5
The Madison Clinic for Pediatric Diabetes and Department of Pediatrics, Division of Endocrinology, University of California San Francisco, San Francisco, California.
6
Seattle Children's Research Institute, Seattle, Washington.
7
Department of Pediatrics, Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas.
8
Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
9
Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
10
Division of Pediatric Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
11
Center for Endocrinology, Diabetes, & Metabolism, Children's Hospital Los Angeles, Los Angeles, California.
12
Department of Educational Psychology, Texas A&M University, College Station, Texas.
13
Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas.
14
Cook Children's Medical Center, Fort Worth, Texas.

Abstract

OBJECTIVES:

The primary objective was to investigate the mediating effects of diabetes management in the relationship between diabetes symptoms and generic health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with type 1 diabetes. The secondary objective explored patient health communication and perceived treatment adherence barriers as mediators in a serial multiple mediator model.

METHODS:

The PedsQL 3.2 Diabetes Module 15-item diabetes symptoms summary score, 18-item diabetes management summary score, and PedsQL 4.0 generic core scales were completed in a 10-site national field test study by 418 AYA aged 13 to 25 years with type 1 diabetes. Diabetes symptoms and diabetes management were tested for bivariate and multivariate linear associations with overall generic HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of diabetes management as an intervening variable between diabetes symptoms and generic HRQOL.

RESULTS:

The predictive effects of diabetes symptoms on HRQOL were mediated in part by diabetes management. In predictive analytics models utilizing multiple regression analyses, demographic and clinical covariates, diabetes symptoms, and diabetes management significantly accounted for 53% of the variance in generic HRQOL (P < 0.001), demonstrating a large effect size. Patient health communication and perceived treatment adherence barriers were significant mediators in an exploratory serial multiple mediator model.

CONCLUSIONS:

Diabetes management explains in part the effects of diabetes symptoms on HRQOL in AYA with type 1 diabetes. Patient health communication to healthcare providers and perceived treatment adherence barriers further explain the mechanism in the relationship between diabetes symptoms and overall HRQOL.

KEYWORDS:

PedsQL; health-related quality of life; patient-reported outcomes; pediatrics; self-management; symptoms; type 1 diabetes

PMID:
29927039
DOI:
10.1111/pedi.12713

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