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Identification of Distinct Self-Management Styles of Adolescents With Type 1 Diabetes

¹ National Institute of Child Health and Human Development, Bethesda, Maryland
² Georgetown University School of Medicine, Washington, DC
³ Mount Washington Pediatric Hospital, Baltimore, Maryland
⁴ Johns Hopkins Medical Institutions, Baltimore, Maryland

Address correspondence and reprint requests to Ronald J. Iannotti, PhD, Prevention Research Branch, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development/NIH/DHHS, 6100 Executive Blvd., 7B05, Bethesda, MD 20892-7510. E-mail: iannottr{at}mail.nih.gov

OBJECTIVE—Using a profile-based approach to the assessment of diabetes management, the purpose of this study was to identify and evaluate an empirically derived classification system of distinct self-management styles.

RESEARCH DESIGN AND METHODS—Youth with type 1 diabetes (n = 156) aged 10–16 years and their parents were administered a modified version of the Diabetes Self-Management Profile (DSMP). Cluster analyses were performed independently on parent and youth report forms to categorize patients based on their patterns of scores in five diabetes self-management areas.

RESULTS—Cluster analyses revealed three self-management styles that emerged from both youth and parent report: a "methodical style" (33%) with an emphasis on careful meal planning and correct insulin administration; an "adaptive style" (46%), characterized by high rates of blood glucose testing, exercise, and self-care adjustments; and an "inadequate style" (21%) with moderate rates of self-care adjustments and otherwise low DSMP scores. Convergence between parent and youth report classifications was moderate (Cohen's = 0.47, P < 0.0001). A1C was 1.6% higher in the inadequate style group than in both other groups (P < 0.0001), and the classification significantly accounted for differences in A1C above what was explained by an overall DSMP score.

CONCLUSIONS—The findings provide support for recognizing subgroups of patients with unique multidimensional patterns of self-care behaviors. The assessment of self-management styles may prove useful for customized treatments that are targeted directly to the patients’ needs.

Abbreviations: ADAP, adaptive self-management style • BIC, Bayesian Information Criterion • DSMP, Diabetes Self-Management Profile • INAD, inadequate self-management style • METH, methodical self-management style

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