Objective: Routine screening of diabetes-specific and general psychosocial factors is recommended by ADA. While depression and family functioning have been associated with poorer adherence and metabolic control, research linking peer relations and T1D management is mixed and victimization is not consistently assessed. Youth with T1D are at higher risk of victimization, and those that experience diabetes-specific bullying found to have poorer metabolic control. This study tests a moderated mediation model where peer victimization, moderated by perceived social support, predicts diabetes-related ER visits and whether A1C mediates the relation.

Method and Results: At routine clinic visits, 198 children (ages 7-18) completed the Multidimensional Scale of Perceived Social Support and The Way Kids Are. Chart review was completed. A moderated mediation model explained 18% of the variance in ER visits (p < .001). Social support moderated the relation between victimization and diabetes-related hospitalizations, with strong social support mitigating the relation between victimization and hospitalizations (p = .005). Additionally, A1C mediated the positive relationship between victimization and diabetes-related ER visits; peer victimization was positively related to A1C (p =0.021), which in turn positively predicted ER visits (p < .001).

Conclusions: HbA1C helped explain the positive relationship between peer victimization and diabetes-related ER visits. Additionally, social support appeared to be a protective against hospitalizations. Victimization is a stressor that may directly or indirectly impact blood glucose levels via self-management. Youth who experience greater peer victimization may be less likely to engage in diabetes management in social situations. Victimization should be screened and youth helped to build self-efficacy and confidence related to managing their diabetes around peers.


S. Stromberg: None. M.A. Faith: None. M. Feldman: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.