How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control
Open accessAbstract
Objective Detriments in quality of life (QOL) may contribute to the common, costly decline in adolescents' type 1 diabetes management and control, yet we know little about how this might happen.Methods Participants were 150 adolescents (age 13-18) with type 1 diabetes and their parents. We constructed a latent QOL variable from a multi-informant, multi-domain assessment when participants entered the study. The QOL variable was examined in relation to prospective assessments of diabetes management (blood glucose monitoring frequency; BGM) and control (hemoglobin A1c). We used an indirect path model to test the links among these variables, using bias-corrected bootstrapping.Results Poorer QOL at baseline was indirectly linked with higher A1c at 12 months via less frequent BGM obtained at 6 months (b = -0.01, 95% CI = -0.025, -0.004, p < 0.05). Older age (b = -0.32), longer diabetes duration (b = -0.07), and insulin delivery via injections versus the insulin pump (b = 0.67) were covariates of less frequent BGM, and unmarried caregiver status was associated with higher A1c (b = -0.76), all ps < 0.05.Conclusions In this study, poorer QOL acted as a barrier to effective diabetes management, subsequently altering diabetes control.Practice implications Efforts to monitor and enhance QOL may hold promise for improving adolescents' diabetes outcomes in the future.
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A worse quality of life predicts later worse glycaemic control.
“Furthermore, poor quality of life is predictive of subsequent poor glycaemic control.133”
From Type 1 diabetes (2018) · cites this paper as [133]
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Parental Stress as a Child With Diabetes Transitions From Adolescence to Emerging Adulthood
Tomette, A., Henderson, J. N., Hass, A., Carson, L. D., & King, K. (2019) · Journal of Patient Experience · doi:10.1177/2374373519842963 · Cited by 12 · see citing works
“As the child with diabetes (CWD) ages and develops into adolescence, diabetes management and control may begin to lapse, resulting in increased risk of medical complications for the child (2).”
BackgroundTitoria, R., Fung, A., Tang, T. S., & Amed, S. (2023) · Diabetic Medicine · doi:10.1111/dme.15172 · Cited by 11 · see citing works
Predieri, B., Bruzzi, P., Bigi, E., Boncompagni, A., Bocchi, F., Cenciarelli, V., Madeo, S. F., Poluzzi, S., Pugliese, M., Toffoli, C., et al. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13042 · Cited by 9 · see citing works
Nikitina, I. L., & Kelmanson, I. A. (2021) · European Journal of Pediatrics · doi:10.1007/s00431-021-04239-0 · Cited by 9 · see citing works
Hvidoere Smiley Faces: International diabetes quality of life assessment tool for young children
Hoey, H., Lange, K., Skinner, T. C., Mortensen, H. B., Swift, P. G. F., Aanstoot, H., Castaño, L. A., Cameron, F. J., de Beaufort, C. E., & The Hvidoere International Study Group (2017) · Pediatric Diabetes · doi:10.1111/pedi.12602 · Cited by 8 · see citing works
“Some current longitudinal studies have observed that poor QOL predicted less frequent blood glucose measurement and adherence along with poorer diabetes control.(21,22) This is another argument to screen regularly for impaired QOL in order to identify individual burdensome psychosocial issues even in the youngest coho…”
BackgroundSpirkova, A., Dušátková, P., Pecková, M., Koloušková, S., Šnajderová, M., Obermannová, B., Štechová, K., Hrachovinová, T., Mareš, J., Cinek, O., et al. (2015) · International Journal of Endocrinology · doi:10.1155/2015/185859 · Cited by 8 · see citing works
“The early recognition of a subgroup of children with diabetes with a decreased quality of life is of utmost importance, as it is frequently associated with an increased psychosocial distress potentially leading to a worse treatment adherence andT1D control [5, 6].”
BackgroundAbualula, N. A., Rodan, M. F., Milligan, R. A., & Jacobsen, K. H. (2017) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.09.013 · Cited by 8 · see citing works
Essaddam, L., Mansour, A. B., Amor, A. B., Ravens‐Sieberer, U., Janke, T. M., & Bêcher, S. B. (2018) · Libyan Journal of Medicine · doi:10.1080/19932820.2018.1537457 · Cited by 8 · see citing works
“Evidence shows that better HRQOL is associated with better metabolic control although this relationship is modest, in many studies [5,21].”
ResultFischer, K. I., Fischer, F. H., Barthel, D., Otto, C., Thyen, U., Klein, M. O., Walter, O., Ravens‐Sieberer, U., Rose, M., & Nolte, S. (2020) · Frontiers in Pediatrics · doi:10.3389/fped.2019.00566 · Cited by 7 · see citing works
“(18), HRQL does not only function as a classical outcome parameter but might also serve as measure to identify problems in physical, emotional or social well-being, i.”
BackgroundInfluentialGeneral Anxiety, Diabetes-Specific Anxiety, and Quality of Life in Adolescents With Type 1 Diabetes
Rechenberg, K., & Koerner, R. (2022) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106221125689 · Cited by 6 · see citing works
Associated factors with the quality of life of adolescents with type 1 diabetes
Marques, R. D. M. B., Rodrigues, M. L. D. M., Marini, A. C. B., Santos, C. R. D. C., & Schincaglia, R. M. (2021) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2020.12.018 · Cited by 6 · see citing works
Smuđa, M., Milenković, T., Minaković, I., Zdravković, V., Mitic, S., & Milutinović, D. (2023) · Nursing Open · doi:10.1002/nop2.1993 · Cited by 4 · see citing works
“HRQOL refers to the degree to which the disease and burden imposed by its (self)management affect a person's usual or expected physical, emotional, and social well-being (Hilliard et al., 2013).”
BackgroundDiabetes distress among caregivers of adolescents with type 1 diabetes
McCarty, T., Inverso, H., Streisand, R. M., Garretson, S., Straton, E., Okonkwo, N., & Jaser, S. S. (2025) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsaf051 · Cited by 3 · see citing works
“Caregiver DD has also been linked to reduced quality of life and depression in teens, both of which impact diabetes management (Abadula et al., 2024; Harrington et al., 2021; Hilliard et al., 2013).”
T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications
Tran, P. M. H., Kim, E., Tran, L. K. H., Satter, K. B., Zhi, W., Bai, S., Hopkins, D., Gardiner, M., Bryant, J., Bernard, R., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111094 · Cited by 3 · see citing works
“Other factors have been associated with risk of microvascular complications in cross-sectional and longitudinal studies, including sex [10], onset of type 1 diabetes during puberty [11], glycemic variability [12], quality of life during adolescence [13], and hypertension [14].”
BackgroundBurlaka, I. A., Mityuryayeva-Kornijko, I. O., Shevchenko, T. A., Holoborodko, A. D., Kovalchuk, I. V., & Lantukh, L. O. (2021) · Global Pediatric Health · doi:10.1177/2333794x211063052 · Cited by 3 · see citing works
Noncompliance and Nonadherence
Lemanek, K. L., & Yardley, H. L. (2019) · Autism and child psychopathology series · doi:10.1007/978-3-030-21683-2_25 · Cited by 2 · see citing works
Martín-Martínez, N., Caro‐Cañizares, I., Carballo, J. J., & Parellada, M. (2025) · European Journal of Pediatrics · doi:10.1007/s00431-025-06266-7 · Cited by 1 · see citing works
Alsada, S. A., Ba-Essa, E. M., & Alsaffar, A. A. (2020) · Advances in Medicine · doi:10.1155/2020/1247294 · Cited by 1 · see citing works
“Internationally, there have been a limited number of studies that have evaluated glycemic control trajectories for patients with T1DM [11, 15–21], and many studies have focused on the psychiatric aspects of T1DM and the family dynamic effects concerning glycemic control for adolescents with T1DM [15, 16].”
BackgroundHilliard, M. E., Levy, W. L., Weinstock, R. S., Hood, K. K., Trief, P. M., DeSalvo, D. J., Rojas, Y., Holland, K., Schneider‐Utaka, A. K., ALAMARIE, S. A., et al. (2025) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2025.101491 · Cited by 1 · see citing works
“HRQOL is increasingly recognized as a key PRO related to health outcomes [14 – 16].”
Self-citationEucerin impedes transdermal insulin delivery by sonophoresis in rats
Jabbari, N., Mikaili, P., Asghari, M. H., & Ahmadin, H. (2016) · Journal of Applied Pharmaceutical Science · doi:10.7324/japs.2016.601027 · Cited by 1 · see citing works
“At present, subcutaneous injection of insulin is the most common treatment method in patients with diabetes mellitus type 1 which affects their quality of life due to its invasive nature (Li et al., 2014; Hilliard et al., 2013).”
MethodHeeft zelfeffectiviteit een positieve invloed op het diabetesmanagement van adolescenten?
van Eekeren, C. M. T., & van Staa, A. L. (2015) · Nederlands Tijdschrift voor Diabetologie · doi:10.1007/s12467-015-0019-8
Lemanek, K. L., & Yardley, H. L. (2018) · Springer eBooks · doi:10.1007/978-3-030-00791-1_20
Tafti, M. F., Talebian, N., Shokri, P., Shabani-Derakhshan, S., Hadeiy, S. K., Jafari, A., Pirdehghan, A., & Razavi, Z. (2026) · Shiraz E-Medical Journal · doi:10.5812/semj-163662
The Role Of Authoritative Parenting In Type 1 Diabetes Adolescent Outcomes
Radcliff, Z. (2014) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/xxbh-ce82
- Authors
- Hilliard, M. E., Mann, K. A., Peugh, J. L., & Hood, K. K.
- Affiliations
- Johns Hopkins University (US)
- Cincinnati Children's Hospital Medical Center (US)
- University of California, San Francisco (US)
- Corresponding author
- Hood, Korey K.
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 91
- Issue
- 1
- Pages
- 120-125
- ISSN
- 0738-3991 (ISSN-L)
- PMC
- PMC4467557
- OpenAlex
- W2027012943
- Cited by
- 56
- References
- 54
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 8 · 2016: 7 · 2015: 6 · 2014: 5 · 2013: 1
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (DK077340)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, adolescents, quality of life, glycemic control, HbA1c, blood glucose monitoring, diabetes management, insulin pump, insulin injection, caregiver status, diabetes duration
- MeSH terms
- Choice Behavior, Humans, Male, Surveys and Questionnaires, Writing
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