Aim: Affect and social context are associated with diabetes self-care in teens with T1D. We used EMA to examine associations of affect and social context with BG levels in teens with T1D.

Methods: Over 2 weeks, 32 teens reported positive (POS) and negative (NEG) affect (Positive and Negative Affect Schedule) and BG levels on handheld computers 4 times/day, coordinated with daily BG checks; at 3/4 times, teens also reported attitudes toward social context (i.e., strong desire to blend in, strong desire to impress others). Z-scores were calculated for NEG and POS subscales to reflect deviations from each teen’s overall affect. BG values were classified: 1) time in range (TIR) 70-180 mg/dL; 2) low <70 mg/dL; 3) serious low <54 mg/dL; 4) high >180 mg/dL; 5) serious high >250 mg/dL. Separate logistic generalized estimating equations, adjusted for age, sex, T1D duration, pump therapy, and A1c, determined associations between affect, social context, and BG ranges.

Results: Teens (44% male) were ages 14-18 years with T1D duration of 8.8±4.2 (M±SD) years; 63% were pump treated and A1c was 8.8±1.4%. Median 2-week EMA response rate was 72%. Average NEG and POS affect scores were 1.4±0.5 and 2.4±1.1, respectively. Teens reported a desire to impress others 8% of time and desire to blend in 9% of time. Teens reported 51% TIR, 6% low (2% serious low), and 44% high (19% serious high) BG. In adjusted models, more NEG affect was associated with lower odds of reporting a serious low BG (OR= 0.5, 95% CI: 0.3-0.9, p=.03) and higher odds of reporting a serious high BG (OR= 1.2, 95% CI: 1.1-1.4, p=.0002). NEG affect was not associated with TIR, low BG, or high BG. Neither POS affect nor social context were associated with any BG ranges.

Conclusions: In our sample, NEG affect was associated with BG >250 mg/dL. Teens with T1D who experience NEG affect may not attend to diabetes self-care. Interventions targeting NEG affect may help improve diabetes self-care behaviors in teens with T1D.


A. Shapira: None. L.K. Volkening: None. J. Borus: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.


JDRF International; National Institutes of Health (P30DK036836, K12DK094721)

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