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. 目的构建模型,说明患有1型糖尿病青少年从基准时间糖尿病困扰、同龄人反应归因、父母教养方式以及3个月自我管理到6个月糖化血红蛋白水平的转变途径。设计采用前瞻性设计。方法共选取台湾四所医院177名10‐19岁患有1型糖尿病的青少年作为研究对象。于基准时间收集糖尿病困扰、同龄人反应归因和父母教养方式情况数据,于第3个月收集自我管理情况数据,于第6个月收集糖化血红蛋白水平数据。数据于2015年5月至2016年6月期间收集。结果基准时间糖尿病困扰和3个月的自我管理对6个月时的糖化血红蛋白水平有直接影响。基准时间同龄人反应归因会直接影响基准时间糖尿病困扰以及3个月的自我管理情况;同时,它还通过3个月的自我管理对6个月时的糖化血红蛋白水平产生间接影响。基准时间父母教养方式对基准时间糖尿病困扰