How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control

Objective: Detriments in quality of life (QOL) may contribute to the common, costly decline in adolescents' type 1 diabetes management and control, yet we know little about how this might happen.

Methods: Participants were 150 adolescents (age 13-18) with type 1 diabetes and their parents. We constructed a latent QOL variable from a multi-informant, multi-domain assessment when participants entered the study. The QOL variable was examined in relation to prospective assessments of diabetes management (blood glucose monitoring frequency; BGM) and control (hemoglobin A1c). We used an indirect path model to test the links among these variables, using bias-corrected bootstrapping.

Results: Poorer QOL at baseline was indirectly linked with higher A1c at 12 months via less frequent BGM obtained at 6 months (b = -0.01, 95% CI = -0.025, -0.004, p < 0.05). Older age (b = -0.32), longer diabetes duration (b = -0.07), and insulin delivery via injections versus the insulin pump (b = 0.67) were covariates of less frequent BGM, and unmarried caregiver status was associated with higher A1c (b = -0.76), all ps < 0.05.

Conclusions: In this study, poorer QOL acted as a barrier to effective diabetes management, subsequently altering diabetes control.

Practice implications: Efforts to monitor and enhance QOL may hold promise for improving adolescents' diabetes outcomes in the future.