Diabetes self-management decrements mediate the relation of stressful life events and Hemoglobin A1c—differences by race/ethnicity in adolescents

Purpose
The aim of the study was to establish whether suboptimal self-management explains the relationship between stressful life events and hemoglobin A1c (HbA1c) in adolescents with type 1 diabetes and whether these relationships differ across race/ethnicity.

Methods
Participants were 6,368 adolescents enrolled in the U.S. T1D Exchange registry. The outcome, HbA1c, was chart-based; predictors and covariates were self-reported. Moderated mediation was tested using Mplus, adjusting for gender, age, insulin treatment modality, and socioeconomic status.

Results
Higher frequency of missed insulin doses and lower frequency of daily self-monitoring of blood glucose partially explained the relationship between past-year stressful life events and higher HbA1c. Mediation by self-monitoring of blood glucose was detected for those who identified as white non-Hispanic and Hispanic, but not for those who identified as African American.

Conclusions
In adolescents, there is some evidence for a behavioral mechanism in the stressor–HbA1c relationship. African American youth may be more resilient against some detrimental behavioral effects of stressors.