Self-Management Competence as a Predictor of Outcomes of Intensive Therapy or Usual Care in Youth With Type 1 Diabetes

Self-Management Competence as a Predictor of Outcomes of Intensive Therapy or Usual Care in Youth With Type 1 Diabetes Tim Wysocki , PHD 1 , Michael A. Harris , PHD 2 , Karen Wilkinson , BSN, CDE 1 , Michelle Sadler , BSN, CDE 2 , Nelly Mauras , MD 1 and Neil H. White , MD 2 3 1 Nemours Children’s Clinic, Jacksonville, Florida 2 Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 3 St. Louis Children’s Hospital, St. Louis, Missouri Address correspondence and reprint requests to Tim Wysocki, PhD, Nemours Children’s Clinic, 807 Childrens Way, Jacksonville, FL 32207. E-mail: twysocki{at}nemours.org . Abstract OBJECTIVE —This article evaluates prediction of HbA 1c during an 18-month randomized trial of intensive therapy (IT) versus usual care (UC) for type 1 diabetes in 142 youth. RESEARCH DESIGN AND METHODS —Patients received a composite score for self-management competence (SMC) that combined standardized scores on baseline measures of diabetes knowledge, treatment adherence, and quality of health care interactions. They were categorized by tertiles split into low, moderate, and high SMC levels. RESULTS —IT yielded very similar mean HbA 1c levels in all three SMC groups. However, in UC patients, HbA 1c increased markedly for low-SMC youth but not for moderate- and high-SMC youth during the trial. Compared with the mean HbA 1c of their UC counterparts, low-SMC patients realized greater glycemic benefit from IT than did the moderate- or high-SMC youth. Baseline SMC was more strongly correlated with HbA 1c for UC than IT. CONCLUSIONS —All three SMC groups realized similar glycemic benefits from IT. The mean HbA 1c levels of low-SMC patients in the UC group increased markedly over 18 months, whereas HbA 1c levels of low-SMC patients in the IT group did not differ significantly from that of moderate- and high-SMC patients. Relative to their UC counterparts, low-SMC patients derived greater glycemic benefit from IT than did moderate- or high-SMC youth. SMC may be more critical to the success of UC than IT. Perhaps more importantly, patients should not be denied access to IT on the basis of limited competence in diabetes self-management. DCCT, Diabetes Control and Complications Trial DISC, Diabetes Information Survey for Children DSMP, Diabetes Self-Management Profile IT, intensive therapy PSQ, Physician Satisfaction Questionnaire SMC, self-management competence UC, usual care Footnotes A table elsewhere in this issue shows conve