Relationship between disinhibition and metabolic control in adolescents with type 1 diabetes

Abstract

Given that adolescence poses a high-risk period for diabetes mismanagement, and consequently, threats to long-term health status, it is important to examine factors that contribute to individual differences in the propensity to exhibit poor management and engage in health incompatible behaviors. Importantly, researchers have identified personality constructs related to disinhibition, including impulsivity, sensation seeking, and risk-taking propensity, to be prospectively linked to engagement in real-world risk behaviors such as use of alcohol, nicotine, illegal drugs, and risky sexual behavior (Lejuez et al., 2002, 2003). However, this relationship has yet to be explored in adolescents with diabetes. Thus, the purpose of the current study was to examine whether disinhibition was related to metabolic control, and the extent to which self-management behavior and drug/alcohol use mediated this potential relationship. The sample consisted of 43 subjects with Type 1 diabetes aged 13-18 years who were recruited from diabetes clinics at Children's National Medical Center. Teens were assessed with self-report and behavioral measures of risk-taking and participated in an interview regarding self-management behaviors. Substance use and diabetes knowledge were measured by self report, and the glycosylated hemoglobin (HbA1c) test was used as a proxy for metabolic control. Results of partial correlational analyses indicated that disinhibition was not directly related to behavioral adherence, engagement in health incompatible behaviors, or glycemic control after controlling for race, gender, and insulin regimen type. Rather, results of regressional analyses suggested that sample characteristics, particularly race and insulin regimen, are the key variables in assessing overall management in adolescence. Results may have important implications for the prevention and treatment of morbidity associated with diabetes.