Self-care autonomy and outcomes of intensive therapy or usual care in youth with type 1 diabetes

Tim Wysocki; Michael A. Harris; Lisa M. Buckloh; Karen Wilkinson; Michelle Sadler; Nelly Mauras; Neil H. White

doi:10.1093/jpepsy/jsj017

Self-care autonomy and outcomes of intensive therapy or usual care in youth with type 1 diabetes

Tim Wysocki, Michael A. Harris, Lisa M. Buckloh, Karen Wilkinson, Michelle Sadler, Nelly Mauras, Neil H. White

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Objective: This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA_1C) in 142 youths with diabetes. Methods: Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Results: Higher baseline AMR was associated with higher baseline HbA_1C for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Conclusion: Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.

Original language	English
Pages (from-to)	1036-1045
Number of pages	10
Journal	Journal of pediatric psychology
Volume	31
Issue number	10
DOIs	https://doi.org/10.1093/jpepsy/jsj017
State	Published - Nov 2006

Keywords

Adolescents
Children
Intensive therapy
Type 1 diabetes

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title = "Self-care autonomy and outcomes of intensive therapy or usual care in youth with type 1 diabetes",

abstract = "Objective: This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA1C) in 142 youths with diabetes. Methods: Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Results: Higher baseline AMR was associated with higher baseline HbA1C for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Conclusion: Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.",

keywords = "Adolescents, Children, Intensive therapy, Type 1 diabetes",

author = "Tim Wysocki and Harris, {Michael A.} and Buckloh, {Lisa M.} and Karen Wilkinson and Michelle Sadler and Nelly Mauras and White, {Neil H.}",

note = "Funding Information: This study was supported by NIH grant #1-RO1-DK50860 to the first author; and NIH grants #P60-DK20579 and #RR00036 which support the Diabetes Research and Training Center and General Clinical Research Center at the Washington University School of Medicine. Portions of these data were presented at the 63rd Scientific Sessions of the American Diabetes Association, New Orleans, June 16, 2003 and were published as an abstract in Diabetes, 52, Supplement 1, page A39.",

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AU - Harris, Michael A.

AU - Buckloh, Lisa M.

AU - Wilkinson, Karen

AU - Sadler, Michelle

AU - Mauras, Nelly

AU - White, Neil H.

N1 - Funding Information: This study was supported by NIH grant #1-RO1-DK50860 to the first author; and NIH grants #P60-DK20579 and #RR00036 which support the Diabetes Research and Training Center and General Clinical Research Center at the Washington University School of Medicine. Portions of these data were presented at the 63rd Scientific Sessions of the American Diabetes Association, New Orleans, June 16, 2003 and were published as an abstract in Diabetes, 52, Supplement 1, page A39.

PY - 2006/11

Y1 - 2006/11

N2 - Objective: This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA1C) in 142 youths with diabetes. Methods: Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Results: Higher baseline AMR was associated with higher baseline HbA1C for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Conclusion: Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.

AB - Objective: This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA1C) in 142 youths with diabetes. Methods: Youths received an autonomy/maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Results: Higher baseline AMR was associated with higher baseline HbA1C for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Conclusion: Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT.

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Self-care autonomy and outcomes of intensive therapy or usual care in youth with type 1 diabetes

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