Hilliard Marisa E, Hagger Virginia, Hendrieckx Christel, Anderson Barbara J, Trawley Steven, Jack Michelle M, Pouwer Frans, Skinner Timothy, Speight Jane
Section of Psychology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
School of Psychology, Deakin University, Geelong, VIC, Australia.
Diabetes Care. 2017 Jul;40(7):849-855. doi: 10.2337/dc16-2688. Epub 2017 Apr 26.
Despite the challenges of living with type 1 diabetes, many adolescents achieve "resilient outcomes": high engagement in self-management behaviors such as self-monitoring of blood glucose (SMBG), good quality of life (QOL), and within-target glycemic outcomes (HbA). Adaptive diabetes-related behaviors (i.e., "strengths") are associated with resilient outcomes, yet the combination of risks and strengths in relation to resilient outcomes is unclear. The aim of this study was to investigate relations among diabetes strengths and resilient outcomes in the context of psychological and family risk factors.
A total of 471 Australian adolescents with type 1 diabetes (mean age 15.7 ± 1.9 years; diabetes duration 6.9 ± 4.2 years; 62% female; 53% using insulin pumps) completed a national cross-sectional survey about their diabetes-related strengths, risk factors (depressive/anxiety symptoms, family conflict), and resilient outcomes (SMBG frequency, general QOL, HbA).
Greater diabetes strengths were significantly related to resilient outcomes: more frequent SMBG ( = 0.39), lower HbA ( = -0.31), and higher general QOL ( = 0.50), as well as to lower risks: fewer depressive ( = -0.45) and anxiety ( = -0.40) symptoms and less conflict ( = 0.28). In multivariate regressions, diabetes strengths consistently related to all resilient outcomes beyond significant risk factors.
In a large sample of Australian adolescents, diabetes strengths were strongly related to key resilient outcomes, even in the presence of well-documented psychological and family risk factors. More research is needed to determine whether strengths reduce or buffer other risks. Given the associations with self-management, HbA, and general QOL, monitoring and enhancing diabetes strengths may support resilience promotion during a vulnerable developmental period.
尽管1型糖尿病患者的生活面临诸多挑战，但许多青少年仍能取得“适应性良好的结果”：积极参与自我管理行为，如血糖自我监测（SMBG），生活质量（QOL）良好，血糖水平达标（糖化血红蛋白）。与糖尿病相关的适应性行为（即“优势”）与适应性良好的结果相关，但与适应性良好的结果相关的风险和优势的组合尚不清楚。本研究的目的是在心理和家庭风险因素的背景下，调查糖尿病优势与适应性良好的结果之间的关系。
共有471名澳大利亚1型糖尿病青少年（平均年龄15.7±1.9岁；糖尿病病程6.9±4.2年；62%为女性；53%使用胰岛素泵）完成了一项关于其糖尿病相关优势、风险因素（抑郁/焦虑症状、家庭冲突）和适应性良好的结果（SMBG频率、总体生活质量、糖化血红蛋白）的全国性横断面调查。
更强的糖尿病相关优势与适应性良好的结果显著相关：更频繁的SMBG（=0.39）、更低的糖化血红蛋白（=-0.31）和更高的总体生活质量（=0.50），同时也与更低的风险相关：更少的抑郁（=-0.45）和焦虑（=-0.40）症状以及更少的冲突（=0.28）。在多变量回归中，除了显著的风险因素外，糖尿病相关优势始终与所有适应性良好的结果相关。
在大量澳大利亚青少年样本中，即使存在充分记录的心理和家庭风险因素，糖尿病相关优势仍与关键的适应性良好的结果密切相关。需要更多研究来确定优势是否能降低或缓冲其他风险。鉴于与自我管理、糖化血红蛋白和总体生活质量的关联，监测和增强糖尿病相关优势可能有助于在脆弱的发育阶段促进适应性。
