患有1型糖尿病青少年血糖控制的个人、父母和同龄人因素模型构建:前瞻性研究

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.