Objective: To identify psychosocial predictors of diabetes self-efficacy (DSE) in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort, now young adults with youth-onset type 2 diabetes (T2D).

Methods: In this longitudinal study (T1=baseline, T2=1 year), 348 TODAY2 participants completed measures of: diabetes self-efficacy, beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes attitudes, self-management support, and material need insecurities. Multivariable logistic regression models evaluated independent associations of each psychosocial factor with the likelihood of being in the high/low DSE tertile groups at T2; multivariable linear regression assessed associations with T2 DSE as a continuous variable.

Results: Mean (SD) age was 26.0 (2.5) years, 67.9% were women, mean (SD) HbA1c= 9.4 (2.8), with mean (SD) of 2.5 (1.4) complications. Greater self-management support increased the odds of high (vs. low) DSE (OR, 2.23, 95% CI, 1.30-3.83, p=0.004). Greater beliefs that medicines are overused (OR, 0.58, 95% CI, 0.34-0.99, p=0.046), moderate-to-severe depression/anxiety symptoms (OR, 0.30/0.03, 95% CI, 0.09-0.97/0.003-0.34, p=0.045/0.004), food insecurity/healthcare coverage insecurity/≥1/≥2 insecurities decreased the odds of high DSE by 80%/65%/78%/74%; p=<0.0001/0.025/0.001/0.001). More support, fewer depressive and anxiety symptoms, and fewer unmet needs were also predictors of absolute T2 DSE scores.

Conclusions: Cognitions (beliefs that medicines are overused), emotions (depressive/anxiety symptoms), and social factors (self-management support, unmet material needs), were significant longitudinal predictors of DSE in young adults with youth-onset T2D. These potentially modifiable factors should be considered when screening for, and designing, interventions to enhance DSE, to improve health behaviors and forestall the development of complications in this at-risk group.

Disclosure

P.M. Trief: None. H. Wen: None. B.J. Anderson-Thomas: None. B.K. Burke: None. J.D. Bulger: None. R.S. Weinstock: Research Support; Eli Lilly and Company, Tandem Diabetes Care, Inc., Diasome, Amgen Inc., MannKind Corporation, Insulet Corporation, Novo Nordisk. Other Relationship; Dexcom, Inc.

Funding

National Institutes of Health (RO1DK110456, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254)

© 2024 by the American Diabetes Association
2024
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