Illness Specific Self-Esteem in Adolescents with Type 1 Diabetes

Abstract

Background: Prior research provides support for a unique diabetes-specific domain of self-esteem in adolescents with Type 1 Diabetes (T1DM). Little is known about the correlates of diabetes specific self-esteem or its relationships to diabetes outcomes.

Methods: Adolescents with T1DM between the ages of 13-21, who were receiving their diabetes care from a pediatric endocrinology clinic of a major urban medical center, were recruited to complete a self-report battery consisting of demographic, psychosocial, and diabetes self-care measures, including measures of general and diabetes specific self-esteem. Regression analyses were used to identify predictors of global and diabetes specific self-esteem and the relationships among global self-esteem, diabetes specific self-esteem, diabetes outcomes (self-care and blood glucose monitoring) and glycemic control.

Results: Participants were 89 adolescents between the ages of 13-21 (M=16.30, SD, 2.47) diagnosed with T1DM for at least one year (duration of disease M= 7.77, SD=4.05). The sample population was ethnically diverse (51.7% Hispanic/Latino; 32.6% Black; 11.2% White; 2.2% Asian; 1.1% other) and primarily socioeconomically disadvantaged (65% earning below $50,000). The majority of participants used an insulin pump as method of insulin administration (62.9%). Glycemic control was poor (M= 10.33, SD=2.23). As As hypothesized, multivariable regression analysis revealed that psychosocial variables (the Problem Areas in Diabetes scale and Self-Rated Health) were significantly associated with diabetes specific self-esteem even when controlling for demographic variables. Diabetes specific self-esteem also accounted for unique variance in diabetes outcomes (frequency of blood glucose monitoring, self-reported self-care, and glycemic control) not accounted for by global self-esteem. Finally, as hypothesized, diabetes specific self-esteem, along with a subjective self-rating measure of adherence, remained independent predictors of glycemic control after controlling for an objective measure of diabetes care (frequency of blood glucose monitoring) and a frequency based self-care measure.

Conclusions: Findings suggest that subjective, non-frequency based measures, such as the Diabetes Self-Esteem Scale and Self-Rated Adherence capture diabetes self-care better than traditional frequency measures. These brief and easily administered measures may serve as useful clinical tools in identifying at risk patients and barriers to diabetes care through questions that explore self-worth in the context of diabetes tasks.