Psychosocial Factors and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes
Authors: Paula M. Trief, Hui Wen, Brian Burke, Diane Uschner, Barbara J. Anderson, Xun Liu, Jane Bulger, Ruth S. Weinstock
Journal: JAMA Network Open (2024)

Importance Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions. Objective To identify psychosocial factors associated with glycated hemoglobin (HbA 1c ) levels in young adults with youth-onset type 2 diabetes. Design, Setting, and Participants For the i Count cohort study, HbA 1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023. Main Outcomes and Measures Glycemic control was examined categorically (high [≥8.0%] vs low [&amp;amp;lt;8.0%] HbA 1c ), continuously (HbA 1c level), and over time (change in HbA 1c : decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA 1c of 8.0% or greater, T2 HbA 1c level, and change in HbA 1c . Results Of the 411 TODAY2 participants approached, 381 enrolled in the i Count study, and 348 with T1 and T2 HbA 1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA 1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA 1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA 1c at T2. Diabetes distress was associated with higher HbA 1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA 1c decrease of at least 0.5% over 1 year. Conclusions and Relevance In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA 1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.