War Related Illness and Injury Study Center (WRIISC), VA New Jersey Health Care System, East Orange, New Jersey.
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York.
Pediatr Diabetes. 2020 Feb;21(1):69-76. doi: 10.1111/pedi.12928. Epub 2019 Nov 12.
Patient-reported outcomes have received increased attention as treatment outcomes and indicators of wellbeing. A1c has been criticized as lacking patient-centered relevance because individuals are often unaware of their A1c, and studies also often fail to show a benefit of intensive control on quality of life. The goal of the present study was to examine self-rated health (SRH) in relation to diabetes self-care behaviors, socioeconomic factors, treatment regimen characteristics, and glycemic control among predominately Hispanic and African American adolescents with type 1 diabetes (T1D).
Adolescents with T1D (N = 84) were recruited for a cross-sectional study evaluating psychosocial factors and identity development. SRH, self-care behaviors, treatment regimen, and demographic variables were collected through self-report while glycemic control (A1c) was determined through chart review.
Participants were predominantly racial and ethnic minorities (48% Hispanic, 27% African American; 52% female, M age 15.9, M diabetes duration 6.8, M A1c 10% [86 mmol/mol]). Significant bivariate relationships emerged between SRH and sex, A1c, self-care behavior, and insulin delivery method. Covariate-adjusted regression models showed only A1c was significantly and independently related to SRH. Mediation analyses illustrated a significant indirect effect for A1c between self-care and SRH.
These findings suggest glycemic control is associated with self-ratings of health among ethnically diverse adolescents with T1D. SRH appears to be an appropriate patient-reported outcome that is sensitive to glycemic control in this population.
患者报告的结果作为治疗结果和幸福感的指标受到了越来越多的关注。A1c 因缺乏以患者为中心的相关性而受到批评，因为个体通常不知道自己的 A1c，而且研究也经常未能显示强化控制对生活质量的益处。本研究的目的是检查自我报告的健康状况（SRH）与糖尿病自我护理行为、社会经济因素、治疗方案特征以及主要为西班牙裔和非裔美国青少年 1 型糖尿病（T1D）患者的血糖控制之间的关系。
招募了 84 名患有 T1D 的青少年参加一项横断面研究，评估心理社会因素和身份发展。通过自我报告收集 SRH、自我护理行为、治疗方案和人口统计学变量，而通过图表审查确定血糖控制（A1c）。
参与者主要是种族和少数民族（48%西班牙裔，27%非裔美国人；52%女性，平均年龄 15.9 岁，平均糖尿病病程 6.8 年，平均 A1c 为 10%[86mmol/mol]）。SRH 与性别、A1c、自我护理行为和胰岛素输送方式之间存在显著的双变量关系。调整协变量的回归模型显示，只有 A1c 与 SRH 显著独立相关。中介分析表明，A1c 在自我护理和 SRH 之间存在显著的间接效应。
这些发现表明，血糖控制与 T1D 种族多样化青少年的自我报告健康状况相关。SRH 似乎是一种合适的患者报告结果，在该人群中对血糖控制敏感。
