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)