Journal of Pediatric Psychology 31(10) pp. 1036–1045, 2006 doi:10.1093/jpepsy/jsj017

Objective This article evaluated whether deviation from developmentally appropriate self-care autonomy moderated the effects of intensive therapy (IT) or usual care (UC) on glycosylated hemoglobin (HbA1C) in 142 youths with diabetes. Methods Youths received an autonomy/ maturity ratio (AMR) score at baseline that was a ratio of standardized scores on measures of self-care autonomy to standardized scores on measures of psychological maturity and were categorized by tertile split into low, moderate, and high AMR. Results Higher baseline AMR was associated with higher baseline HbA1C for IT and UC. Baseline AMR scores predicted glycemic outcomes from UC; the high AMR tertile showed deteriorating glycemic control over time, whereas the low AMR tertile maintained better glycemic control. All three AMR groups derived equal glycemic benefit from IT. Conclusion Children with inordinate diabetes self-care autonomy may fare poorly in UC but these same children may realize less glycemic deterioration during IT. Key words adolescents; children; intensive therapy; type 1 diabetes. The Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) study proved that prolonged maintenance of excellent glycemic control through intensive therapy (IT) including extensive multidisci-plinary support delayed the onset and slowed the pro-gression of long-term complications of type 1 diabete