Perceptions of Health Risk in

Youth with Type 1 Diabetes

Alan Delamater, Amber Daigre, Elizabeth
Pulgaron, Anna Maria Patino-Fernandez,
Janine Sanchez
University of Miami Miller School of Medicine
Miami, Florida

Presenter Disclosure Information

Alan Delamater, PhD

This research supported in part by a
research training grant (T32HD007510)
Consultant to Novo Nordisk and Sanofi
(unrelated to current research)

% Teens Meeting A1c Targets

In Denmark, 31% <7.5%

In Sweden, 35% <8%
In UK, 14.5% <7.5%; 30% >9.5%
In US SEARCH study, 32% <7.5%; 17% T1D
and 27% T2D >9.5%
In T1D Exchange, less than 30% <7.5%
Poor glycemic control associated with ethnic
minority status and longer duration of
diabetes
Better control with increased SMBG and
insulin pump

Realities

Despite advances in treatment, most

children and adolescents do not meet
glycemic goals, and prognosis is not
optimal
Number of life years lost has remained
unchanged over last four decades
(approx. 15 years for children
diagnosed prior to age 10 yrs)
Keeping A1c near normal early in
disease course may be protective

Ecological Model of
Predictors of
Glycemic Control

Medical System
Characteristics

Health
insurance

School
Health
Policies

Parent, Family, & Social

Factors

Parental
regimen
Age and
knowledge
Gender;
Diabetes
duration
Parental
psychological
Dietary
status
skills and
adherence

Parental
monitoring and
support

Relationship
with doctor

Child
Characteristics
Racial and
ethnic status

Child Glycemic
Control

Neurocognitive and
psychological

Peer relations
and support

SMBG &
Insulin
Adherence

Contacts with
health care
team
Family SES;
Single or two
parent home

Family
Physical Activity organization
and routines

Parent-child
conflict

Davidson & Birch, 2001

Psychological Predictors of
Diabetes Management

Health Belief Model (Janz & Becker, 1984):

Threat Perceptionsseverity and
susceptibility
Behavioral Evaluationbenefits,
barriers, and cues

HBM Research with Adolescents

Brownlee-Duffeck et al. (1987)costs

predict adherence; severity and
susceptibility predict glycemic control
Bond et al. (1992)benefits, costs, and
cues predict adherence; threat predicts
adherence when benefits are low; when
threat is low and cues high, predicts
A1c

Optimistic Bias

Easier to assign risk to others rather

than selfunderestimate risk to self
Patino et al. (2005): health risk
perceptions did not predict adherence,
but greater short-term risk related to
higher A1c
Short-term risk greater than long-term
risk, and risks for others greater than
risks for self

Health Risk Perception

One psychological factor to help

understand whether patients adhere to
medical regimens
With youth, important to differentiate
short-term and longer-term risks
(Skinner et al., 2002)

Short-term day-to-day risks more

salient for younger patients
Longer-term risks influenced by higherorder cognitive function and maturity

Research Addressing How to

Deal with Complications

Buckloh et al. (2008)--focus group with

parents of youth with T1D: anxiety; need
more communication and support from HCT;
avoiding topic vs. scare tactics; how to
motivate youth
Lochrie et al. (2009)survey of HCPs:
sensitive issue with wide variation in
amount, timing, and delivery of information;
more with parents and older youth, upon
parental inquiry, dependent on patient
characteristics

Research Addressing How to

Deal with Complications

Wysocki et al. (2011)cross-sectional

study of youth and parents about
knowledge and communication about
major health complications
Youth (but not parent) knowledge
predicted better adherence
More frequent optimistic family
communication predicted better youth
outcomes

Purpose of Study

Examine whether perceptions of health

risk are related to intellectual ability
and executive function, as well as with
adherence and glycemic control
Test whether long-term risks are less
than short-term risks
Test whether risks to self are less than
risk assigned to others

Method

Recruited 70 youth (mostly low-income

ethnic minority): 60% Hispanic, 26%
Black, 14% non-Hispanic White
Mean age of 13.2 years (range 11-16.8
years)
Mean duration of T1D of 4.4 years
Mean A1c of 9.3%

Measures

Administered Diabetes Health Belief

Questionnaire (seriousness and
susceptibility) and Diabetes related
Health Problems Scale (short and longterm risk to self and others)
Self Care Inventory completed by youth
and parents
Administered WISC, Trails B, and
Categories Test to measure intelligence
and executive functioning

Health Risk

Short and Long-Term Health Risk for

Self and Others

Cognitive
Ability

Executive
Function

Health Risk
Perceptions

Regimen
Adherence

Glycemic
Control

Cognitive
Ability

Executive
Function

ns

-.26
Health Risk
Perceptions
-.25

Regimen
Adherence

.24

-.29

Glycemic
Control

Results

Better adherence was related to decreased

long-term risk to self and others
Higher A1c was associated with increased
short-term risk to self and long-term risk to
others
Higher non-verbal reasoning was related to
less susceptibility and short-term risk to self
Higher intelligence (r=-.33, p<.01) and
executive functioning (r=-.27, p<.05)
associated with lower A1c

Summary

Youth perceive relatively low levels of

diabetes-related health risks
Short-term risks were significantly less than
long-term risks
Risks to self were significantly less than risk
to others
Some evidence that youth health risk
perceptions are associated with regimen
adherence, glycemic control, and cognitive
abilities

Limitations

Small study sample

Cross-sectional correlational study
design
Relatively little variance accounted for
Multiple tests

Conclusions

Youth perceive relatively low levels of health

risks to themselves, but acknowledge greater
risks to others
Short-term risks are perceived as greater
than long-term risks
Risk perceptions seem accurate in
relationship to adherence and glycemic
control
Important for parents and HCPs to have
discussions with youth about diabetesrelated health risks, both short and long-term