Date of Award

December 2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Julia A. Snethen

Committee Members

Aaron Buseh, Anthony Hains, Dora Clayton-Jones, Elizabeth Cox

Keywords

Disparity, Health Related Quality of Life, Metabolic Control, Pediatrics, Social Isolation, Type 1 Diabetes

Abstract

ABSTRACT

TYPE 1 DIABETES: FACTORS THAT AFFECT YOUTH/PARENT DYADS’ QUALITY OF LIFE AND YOUTH METABOLIC CONTROL

by

Joan Pennington Totka

The University of Wisconsin-Milwaukee, 2016

Under the Supervision of Professor Julia Snethen

Type 1 Diabetes (T1D) is one of the most psychologically and behaviorally demanding of all chronic illnesses for youth (preadolescents and adolescents) with T1D and their primary caregivers. T1D affects one out of every 400 to 600 youth, making it one of the most common chronic conditions in school-aged youth in the United States. Advances in technology and treatment continue; however, more than 80% of youth do not meet goals for metabolic control measured by glycosylated hemoglobin (A1c test result). A higher A1c increases the risks for blindness, nephropathy, neuropathy, amputations and heart disease. The purpose of this secondary analysis was to explore associations of the health-related quality of life (HRQOL) survey and subscales of youth/parent dyads and the A1c of youth with T1D. Additionally, the study examined associations between other individual, family, and diabetes specific factors such as age, gender, ethnicity, socioeconomic status (SES), and use of technology with both HRQOL and A1c of youth with T1D. Results of this study indicate that the youth with T1D’s A1c is predicted in part by the youth’s HRQOL and their ethnicity. Poor A1c was associated with lower HRQOL of youth with T1D. Analysis of preadolescents aged eight to twelve and adolescents aged thirteen to sixteen indicated that their A1c was predicted by different factors. The factor most significantly predictive of A1c of preadolescents was SES; however, the need to eliminate all diversity from this analysis due to the outlier status of non-white youth suggested particular vulnerability associated with ethnicity in that age group. The factors most predictive of A1c results in adolescents were two subscale scores; adolescent HRQOL Treatment 1 subscale and parent HRQOL Social Functioning subscale were predictive of A1c, which may have clinical implications. Tailored interventions based on developmental and individual needs may impact outcomes for youth with T1D and their parents.

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