Modelling individual, parental and peer factors to glycaemic control in adolescents with type 1 diabetes: A prospective study.
AIM
To construct a model addressing the pathways from baseline diabetes distress, attribution of peer reactions, parenting style and 3-month self-management to 6-month glycated haemoglobin levels in adolescents with type 1 diabetes.


DESIGN
A prospective design was adopted.


METHODS
A total of 177 adolescents aged 10-19 with type 1 diabetes were enrolled from four hospitals in Taiwan. Diabetes distress, attribution of peer reactions and parenting style were collected at baseline, self-management was collected at the third month and glycated haemoglobin levels were collected at the sixth month. Data were collected from May 2015-June 2016.


RESULTS
Baseline diabetes distress and 3-month self-management directly affected 6-month glycated haemoglobin levels. Baseline attribution of peer reactions directly affected baseline diabetes distress and 3-month self-management; also, it indirectly affected 6-month glycated haemoglobin levels through 3-month self-management. Baseline parenting style directly affected baseline diabetes distress, baseline attribution of peer reactions, 3-month self-management and 6-month glycated haemoglobin levels; it also indirectly affected 6-month glycated haemoglobin levels through baseline diabetes distress and 3-month self-management.


CONCLUSION
A model simultaneously incorporating individual, parental and peer factors to glycaemic control in adolescents with type 1 diabetes has been constructed. Improving diabetes distress and self-management should be essential strategies to improve glycaemic control in adolescents with type 1 diabetes. Encouraging adolescents with type 1 diabetes to communicate openly with peers about diabetes care and educating their parents to provide more responsive and autonomy-encouraging parenting style might be vital strategies to improve diabetes distress, 3-month self-management and glycaemic control.


IMPACT
Individual, parental and peer factors should be simultaneously considered to improve glycaemic control in adolescents with type 1 diabetes. Nurses should evaluate these factors to tailor interventions improving glycaemic control in adolescents with type 1 diabetes.
['Lee|Shu-Li|SL|https://orcid.org/0000-0002-1736-0307', 'Tsai|Meng-Che|MC|https://orcid.org/0000-0003-1057-3315', 'Chang|Shu-Chen|SC|https://orcid.org/0000-0002-0790-8842', 'Chen|Jyu-Lin|JL|https://orcid.org/0000-0002-8687-4109', 'Wang|Ruey-Hsia|RH|https://orcid.org/0000-0001-9323-7389']
D000293:Adolescent D000328:Adult D015190:Blood Glucose Self-Monitoring D002648:Child D003922:Diabetes Mellitus, Type 1 D005260:Female D006442:Glycated Hemoglobin A D000085002:Glycemic Control D006801:Humans D008297:Male D010290:Parents D010379:Peer Group D011446:Prospective Studies D057566:Self Report D013624:Taiwan D055815:Young Adult
model parents peers glycaemic control adolescents type 1 diabetes diabetes distress self-management nurses