The impact of stress, adherence, and cognitive errors on metabolic control in youths with type I diabetes

The present study examined the role of cognitive errors in the relationship between stress, adherence behavior, and metabolic control. The participants were youths between the ages of 11 and 18 with Type I Diabetes of at least one year duration. Youths completed the Children's Negative Error Questionnaire, the Diabetes Stress Questionnaire, the Life Stressors and Social Resources Inventory, and the Diabetes Compliance Questionnaire. In addition, frequency of blood glucose monitoring over the previous week, based on glucometer readings, was obtained as an objective indicator of adherence. Metabolic control was measured by glycosylated hemoglobin (A1c) assays. Preliminary analyses indicated that females were more likely to check their blood glucose than males and reported more diabetes-specific stress compared to their male counterparts. Consequently, completely identified path models for the self-report measure of adherence and the number of glucometer checks for the entire sample (n = 143), for females (n = 68), and for males (n = 75) are presented. Path coefficients and indices of fit were computed and used to systematically eliminate nonsignificant paths and to formulate parsimonious models. Results suggest that for females the more negative cognitive errors they have the more stress (both diabetes-specific and general) they report. The more general stress then leads to less adherent behavior (both objective and subjective measures) and subsequently poorer metabolic control (higher A1c). More diabetes-specific stress also leads to worse metabolic control. For males, the pattern was somewhat different with more diabetes-specific stress leading to more general stress, which in turn leads to less adherent behavior, and subsequently higher A1c. In addition, a significant direct path between cognitive errors and A1c was found. The findings suggest the role of negative cognitive errors and indicate the potential usefulness of cognitive behavioral interventions in working with youths with Type I Diabetes experiencing problems with stress, adherence, and poor metabolic control.