| Insulin-dependent diabetes mellitus is a lifelong disease requiring a complex medical regimen. A delicate balance must be maintained between high and low blood sugars in order to avoid both hyperglycemia and hypoglycemia. Previous research has shown many factors that influence youths' ability to balance these two health outcomes. This study expanded on previous diabetes research and offered a new framework (goal theory) to explain poor health outcomes. It is the first study to assess diabetes responsibility to determine who to use in analyses (parent or youth). It was assumed that this person (either parent or youth) would have goals that impact most on health outcomes and that differences between parents'/youths' and health professionals' goals were a function of poor communication of goals and/or "adaptive noncompliance." Adaptive noncompliance would have led families to develop systems of self-management suited to their life-styles or personal beliefs.;Youths (N = 78, ages 8 to 18) with diabetes, their parents and their health professionals completed measures assessing diabetes goals. Measures of diabetes responsibility, adherence behaviors, hypoglycemic episodes, and demographics were assessed in youths and parents. Metabolic control was determined by the youths' HbA1c.;It was hypothesized that, first, parents'/youths' diabetes goals would be related to metabolic control and hypoglycemic episodes. Second, adherence to the regimen would moderate the relationships between goals metabolic control and the relationship between goals and and hypoglycemic episodes. Third, larger differences between parents'/youths' and health professionals' blood sugar goals would lead to poorer metabolic control, but fewer episodes of hypoglycemia. Finally, larger differences between adherence goals and metabolic control. Goal differences between parents'/youths' and health professionals' adherence goals would lead to poorer metabolic control and more hypoglycemic episodes. These hypotheses were partially supported. Parents'/youths' goals were related to metabolic control, and adherence behaviors moderated the relationship between parents/youth and their health care providers offered another explanation for both good and poor health outcomes. These findings confirmed the need for clear communication of goals so that patients and health professionals are aware of the consequences of these differences, particularly when patients have less stringent goals than health professionals. |
