605-P: Self-Management Behaviors Mediate the Relationship between Diabetes Burden in Caregivers and A1C

Type 1 Diabetes (T1D) treatment involves engaging in multiple complex and burdensome self-management behaviors daily. The purpose of this study was to examine the relationship between diabetes burden, self-management behaviors, and A1C.

Caregivers of 77 adolescents with T1D (age=14.9±1.9 years, A1C=9.8±1.6%, T1D duration=6.8±3.5 years, 45.5% male) participating in a RCT that provided integrated behavioral intervention to improve A1C completed a short version of Problem Areas in Diabetes-Parent Revised (PAID-PR) at the baseline visit prior to beginning intervention. The Immediate Burden subscale of PAID-PR was used to assess diabetes burden. Objective self-management behaviors were calculated using data downloaded from adolescents’ T1D devices.

As caregiver burden increased, so did the frequency of self-management behaviors of carbohydrate entries per day (r=0.365, p<0.01) and insulin boluses per day (r=0.273, p<0.05) , but not blood glucose readings. Caregiver burden increased as A1C decreased (r=-0.224, p<0.05) . There was a significant indirect effect of diabetes burden on A1C through the self-management behaviors for carbohydrate entries per day (b=-0.023, 95% bias-corrected and accelerated bootstrap (BCa) CI [-0.056, -0.002] and insulin boluses per day (b=-0.016, 95% BCa CI [-0.041, 0.001]) .

Higher T1D self-management is associated with lower A1C, but this may come with a cost- greater feelings of burden due to T1D management. Family interventions to promote teamwork and assist caregivers and adolescents to appropriately distribute responsibility for T1D management may allow for continued high engagement while reducing burden.