Intrinsic Motivation in Ethnic Minority Youth with Type 1 Diabetes.

Increasing intrinsic motivation (IM) may be an effective way to improve regimen adherence and glycemic control in youth with type 1 diabetes (T1D). This preliminary study evaluated the reliability and validity of a new measure of intrinsic motivation for diabetes management for ethnic minority youth with T1D. The 12-item Intrinsic Motivation Inventory for Diabetes Management (IMI-DM) was developed to assess perceptions of confidence in and the importance of engaging in self-care behaviors for diabetes management. Participants included 51 11-16 year-old minority adolescents (M age = 13.5 years) with T1D and their parents. The IMI-DM demonstrated excellent internal consistency (α=.92). Higher IM was associated with better diabetes self-management behaviors and glycemic control, better youth self-concept, less depression and family conflict, and greater youth responsibilities for diabetes management. These findings provide preliminary support for the reliability and validity of a new diabetes-specific IM measure for youth with T1D, and identified some key individual and family factors that may be important to consider in interventions to improve regimen adherence and glycemic control in minority youth with T1D.

Clinic attendance and health outcomes of youth with type 2 diabetes mellitus.

This study assessed whether clinic attendance was related to health outcomes for youth with type 2 diabetes mellitus (type 2 DM). Medical records of pediatric patients with type 2 DM were retrospectively reviewed. Clinic attendance was much more infrequent than recommended by physicians, and 42% of the sample withdrew from medical care. Patients who had a history of not showing during appointments had higher HbA1c levels than those who attended regularly scheduled visits; however, contrary to our hypotheses, average number of clinic visits was not associated with HbA1c levels or zBMI. Given the increased risk for health complications, new strategies are needed to keep patients engaged with medical care.

Glycemic control in young children with diabetes: the role of parental health literacy.

OBJECTIVE: This cross sectional study examined the relationship between parental health literacy (HL), diabetes related numeracy, and parental perceived diabetes self-efficacy on glycemic control in a sample of young children with Type 1 DM. METHODS: Seventy primary caregivers of children (age 3-9 years) with Type 1 DM were recruited and surveyed at diabetes outpatient clinic visits. Patients' medical histories were obtained by medical chart review. RESULTS: Parental diabetes related numeracy (r=-.52, p<01), but not reading skills (r=-.25, p=NS) were inversely correlated with the child's glycemic control (HbA1c). Parental perceived diabetes self-efficacy was also negatively correlated to their child's HbA1c (r=-.47, p<01). When numeracy and parental perceived diabetes self-efficacy were included as predictors of HbA1c, the model was significant (F=12.93, p<.01) with both numeracy (ß=-.46, p<.01) and parental perceived diabetes self-efficacy (ß=-.36, p=.01) as significant predictors of HbA1c. CONCLUSIONS: Data from this study highlight the importance of considering the role of parental numeracy, in health outcomes for children with Type 1 DM. PRACTICE IMPLICATIONS: Practitioners should assess parental health literacy and consider intervention when needed.

Hispanic children and the obesity epidemic: exploring the role of abuelas.

This study evaluated the rate of Hispanic children who have grandparents involved in caretaking and whether grandparents' involvement had a negative impact on feeding practices, children's physical activity, and body mass index (BMI). One-hundred and 99 children and their parents were recruited at an elementary school. Parents completed a questionnaire regarding their children's grandparents' involvement as caretakers and the feeding and physical activity practices of that grandparent when with the child. Children's height and weight were measured and zBMI scores were calculated. Forty-three percent of parents reported that there was a grandparent involved in their child's caretaking. Grandparents served a protective role on zBMI for youth of Hispanic descent, except for the Cuban subgroup. There was no relationship between grandparent involvement and feeding and physical activity behaviors. In some cases grandparents may serve a protective function for childhood obesity. These results highlight the need for future research on grandparents and children's health, especially among Hispanic subgroups.

Measurement of diabetes stress in older children and adolescents with type 1 diabetes mellitus.

OBJECTIVE: Studies indicate general psychological stress plays a role in the glycemic control of individuals with type 1 diabetes mellitus (T1DM). Disease-specific rather than general measures may be more closely related to measures of health outcomes. Therefore, measurement of diabetes-related stress is needed to advance knowledge of significant relationships between stress and glycemic control. The objective of this study was to evaluate the psychometric properties of a measure of diabetes-related stress for youth with T1DM. RESEARCH DESIGN AND METHODS: A 65-item diabetes stress questionnaire for youths (DSQY) was previously developed for use with older children and adolescents. The DSQY was completed by 417 youths with T1DM and the results were analyzed to determine the factor structure and psychometric properties of the questionnaire, as well as relationships of diabetes stress with demographic and clinical variables. RESULTS: A factor analysis of the DSQY yielded an eight-factor solution with acceptable internal consistencies. Significant relationships were observed between glycemic control and stress related to parents and dietary issues. While age and socioeconomic status were unrelated with DSQY scores, higher stress was associated with longer diabetes duration, female gender, and racial/ethnic minority status. CONCLUSIONS: The DSQY is a reliable and valid measure for assessment of diabetes-specific stress in youths with T1DM.

What do Youth with Type 1 Diabetes Know about the HbA1c Test?

The purpose of this study was to examine youths' knowledge of the hemoglobin A1c (HbA1c) test and glycemic control. Seventy youths (11-16 year olds) with type 1 diabetes were interviewed concerning their knowledge of the HbA1c test, health risks associated with particular HbA1c values, and their own glycemic goals. Results revealed that only 13% of youths accurately described the HbA1c test. Fewer correctly identified the HbA1c ranges for good, fair, and poor glycemic control. The majority of youths did not know the blood glucose values corresponding to specific HbA1c results. Only a small number of youth correctly estimated the short-term and long-term risks associated with maintenance of HbA1c of 7% and 12%. In this sample of mostly lower-income, minority youths with type 1 diabetes, there was a significant lack of knowledge concerning the meaning and implications of the HbA1c test. Findings suggest that interventions for this patient population should use the HbA1c test results to help young patients to better understand and set goals for their glycemic control.

Neurocognitive functioning in preschool-age children with type 1 diabetes mellitus.

Neurocognitive functioning may be compromised in children with type 1 diabetes mellitus (T1DM). The factor most consistently implicated in the long-term neurocognitive functioning of children with T1DM is age of onset. The pediatric literature suggests that glycemic extremes may have an effect on the neurocognitive functioning of children, but findings are mixed. The purpose of this study was to compare the neurocognitive functioning of young children with T1DM diagnosed before 6 yr of age and healthy children (i.e., without chronic illness). Additionally, in the children with T1DM, we examined the relationship between their neurocognitive functioning and glycemic control. Sixty-eight (36 with T1DM and 32 without chronic illness) preschool-age children (M age = 4.4 yr ) were recruited and administered a battery of instruments to measure cognitive, language, and fine motor skills. Children with T1DM performed similar to the healthy controls and both groups' skills fell in the average range. Among children with diabetes, poor glycemic control [higher hemoglobin A1c (HbA1c)] was related to lower general cognitive abilities (r = -0.44,p < 0.04), slower fine motor speed (r = -0.64,p < 0.02), and lower receptive language scores (r = -0.39,p < 0.04). Such findings indicate that young children with T1DM already demonstrate some negative neurocognitive effects in association with chronic hyperglycemia.

A Prospective Study of Weight and Metabolic Syndrome in Young Hispanic Children.

OBJECTIVE: Examine weight in young Hispanic children over a two-year period; investigate the relationships among overweight, physical activity, caloric intake, and family history in the development of the metabolic syndrome (MS). METHODS: Forty-seven children (ages 5-8) from diverse Hispanic backgrounds recruited from elementary schools were evaluated. Laboratory analyses, anthropometric data, and measures of physical activity and caloric intake were included. RESULTS: The majority of the children were overweight at baseline (66%) and at follow-up (72%). Children who were overweight at baseline were more likely to exhibit MS at follow-up than were those who were not overweight at baseline. CONCLUSIONS: Overweight appears to be an independent predictor of MS among Hispanic children.

The Psychosocial Assessment Tool (PAT2.0): psychometric properties of a screener for psychosocial distress in families of children newly diagnosed with cancer.

UNLABELLED: Purpose Psychometric properties of the Psychosocial Assessment Tool 2.0 (PAT2.0), a brief screener for psychosocial risk in families of children with cancer, are presented. METHODS: Female (N = 132) and male (N = 72) caregivers of 141 children newly diagnosed with cancer completed the PAT2.0 and measures of child behavior symptoms, anxiety, acute stress, and family functioning to establish validity. Internal consistency and test-retest reliability of the PAT2.0 were also examined. RESULTS: Internal consistency and two-week test-retest for the PAT2.0 Total score was strong. Validity for the PAT2.0 was supported by significant correlations between the PAT2.0 subscales and measures of corresponding constructs. PAT2.0 Total scores were correlated with acute stress and child behavior symptoms for both mothers and fathers. Receiver-Operating Characteristic curves provided preliminary support for the proposed cutoffs. CONCLUSION: The PAT2.0 Total score is a useful screening tool for family psychosocial risk in the pediatric oncology population.

Acute stress in parents of children newly diagnosed with cancer.

OBJECTIVE: Acute Stress Disorder (ASD) and subclinical symptoms of acute stress (SAS) may be a useful framework for understanding the psychological reactions of mothers and fathers of children newly diagnosed with a pediatric malignancy. PATIENTS AND METHODS: Mothers (N = 129) and fathers (N = 72) of 138 children newly diagnosed with cancer completed questionnaires assessing acute distress, anxiety, and family functioning. Demographic data were also gathered. Inclusion criteria were: a confirmed diagnosis of a pediatric malignancy in a child under the age of 18 years without prior chronic or life threatening illness and fluency in English or Spanish. RESULTS: Descriptive statistics and multiple linear regressions were used to examine predictors of SAS. Fifty-one percent (N = 66) of mothers and 40% (N = 29) of fathers met DSM-IV diagnostic criteria for ASD. The majority of the sample reported experiencing at least one SAS. General anxiety, but not family functioning, was a strong predictor of SAS in both mothers and fathers even after controlling for demographic characteristics. CONCLUSIONS: Immediately following their child's diagnosis of cancer, most mothers and fathers experience SAS, with a subsample meeting criteria for ASD. More anxious parents are at heightened risk of more intense reactions. The findings support the need for evidence-based psychosocial support at diagnosis and throughout treatment for families who are at risk for acute distress reactions.