Predictors of diabetes self-care, metabolic control, and mental health in youth with type 1 diabetes

The purpose of this study was to explore the psychosocial predictors of diabetes self-care (adherence to care regimes), metabolic control (glycated haemoglobin), and mental health among rural- and urban-dwelling youth with type 1 diabetes. One hundred and twenty three adolescents/young adults (aged 13-25 years, mean=16 years, standard deviation=3.8 years) with type 1 diabetes, 50 males and 73 females, completed questionnaires reporting on diabetes self-care, metabolic control, mental health (negative affect, quality of life), risk-taking behaviours and attitudes, diabetes self-efficacy, community engagement, and perceived social support. No rural/urban differences were detected on key predictors or outcome variables. Structural equation modelling revealed that high diabetes self-efficacy, lower risk behaviour, and more conservative attitudes to risk taking predicted better diabetes self-care, which in turn predicted better metabolic control and mental health. Social support and engagement in community activities did not influence diabetes self-care. The study has significance because both diabetes self-efficacy and propensity towards risk behaviour are potential targets for educational and counselling interventions designed to improve diabetes self-care regimes and resultant metabolic and mental health outcomes