Treatment for type 1 diabetes is often difficult for adolescents because of the multiple daily tasks required for successful management. Hence, adolescents who are more intrinsically motivated to manage their health might be more persistent with their diabetes care and consequently be in better glycemic control. We therefore examined the proportion of variance that intrinsic motivation contributed to HbA1c in 43 adolescents diagnosed with type 1 diabetes relative to other disease-related and psychosocial factors that have been linked to glycemic control in cross-sectional research.
After receiving approval from the institutional review board, we recruited adolescents with a mean age of 14.14 ± 1.73 years from a university-affiliated diabetes clinic to participate in the study. All of the participants had been diagnosed with diabetes for a minimum of 1 year (M = 5.85 ± 4.53 years), and none were on an insulin pump. The sample consisted mostly of girls (65%); 74% were Caucasian, and 26% were African American. The mean family income was in the $30,000–45,000 range. The adolescents completed standardized measures of intrinsic/extrinsic motivation (Health Self-Determinism Index for Children), self-efficacy (Self-Efficacy for Diabetes Scale), family conflict (Family Environment Scale), diabetes-specific family behaviors (Diabetes Family Behavior Scale), and adherence to their diabetes regimen (Diabetes Regimen Adherence Questionnaire) while waiting for their medical appointment with the physician. Their parents completed a screening measure of behavioral adjustment on the adolescent (Pediatric Symptom Checklist) and a general demographic questionnaire.
Bivariate correlations revealed that adolescents who were more intrinsically motivated to manage their health were more likely to report adhering to their treatment (r = 0.38, P < 0.05) but were also more likely to be in poorer metabolic control, as measured by HbA1c, at the time of testing (r = 0.43, P < 0.05). The relation between intrinsic motivation and poor glycemic control was unexpected, but is consistent with research (1) suggesting that adolescents who are primarily responsible for their diabetes care tend to be in poor metabolic control. Family conflict was also found to be related to poor adherence (r = −0.38, P < 0.05) and to being in poor glycemic control at the time of testing (r = 0.35, P < 0.05). But intrinsic motivation was the only psychosocial variable that was related to HbA1c 4 months later (r = 0.41, P < 0.05). The proportion of variance that intrinsic motivation contributed to future glycemic control, however, was not significant after controlling for baseline HbA1c in hierarchical regression analyses. Given that baseline HbA1c was highly correlated with follow-up HbA1c (r = 0.78, P < 0.0001), further research on intrinsic motivation is worth pursuing with larger samples.
Although we observed significant relations between intrinsic motivation and both adherence and HbA1c, we did not observe a significant relation between adherence and HbA1c at baseline (r = −0.10) or at follow-up (r = −0.06), which is similar to reports in the literature (2). The present findings suggest that adolescents who are intrinsically motivated could be at risk for poor glycemic control because they are more likely to rely on their own internal cues and judgment for managing their health. Adolescents may lack the experience and objectivity to make medically sound judgments. Thus, frequent consultation with parents and medical staff may be recommended instead of encouraging adolescents to assume more personal responsibility for their diabetes care. This recommendation contradicts the popular practice of encouraging adolescents to manage their diabetes care autonomously, but may be warranted until they can successfully manage their diabetes independently.
