Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e912-e919 (doi:10.1542/peds.2007-1484)
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ARTICLE

Self-Management Behaviors, Racial Disparities, and Glycemic Control Among Adolescents With Type 2 Diabetes

Russell L. Rothman, MD, MPPa,b, Shelagh Mulvaney, PhDc,d, Tom A. Elasy, MD, MPHa,b, Ann VanderWoude, MSN, APRN, CDEd, Tebeb Gebretsadik, MPHe, Ayumi Shintani, PhD, MPHe, Amy Potter, MDd, William E. Russell, MDb,d and David Schlundt, PhDb

a Center for Health Services Research
b Diabetes Research and Training Center
c School of Nursing
d Department of Pediatrics
e Department of Biostatistics, Vanderbilt University, Nashville, Tennessee

OBJECTIVE. Type 2 diabetes is a growing problem among adolescents, but little is known about self-management behaviors in this population. Our aim was to examine self-management behaviors and glycemic control among adolescents with type 2 diabetes.

METHODS. From 2003 to 2005, a telephone survey of adolescents with type 2 diabetes was performed. Chart review obtained most recent glycated hemoglobin and clinical characteristics. Analyses compared patient characteristics and self-management behaviors to recent glycated hemoglobin levels.

RESULTS. Of 139 patients contacted, 103 (74%) completed the study. The mean age was 15.4 years: 69% were girls, 47% were white, and 46% were black. Mean glycated hemoglobin was 7.7%, and the average duration of diabetes was 2.0 years. More than 80% of patients reported ≥75% medication compliance, and 59% monitored blood glucose >2 times daily. However, patients reported frequent episodes of overeating, drinking sugary drinks, and eating fast food. More than 70% of patients reported exercising ≥2 times a week, but 68% reported watching ≥2 hours of television daily. Nonwhite patients had higher glycated hemoglobin and hospitalizations per year compared with white patients. In multivariable analyses, nonwhite race remained significantly associated with higher glycated hemoglobin even after adjusting for age, gender, BMI, insurance status, and other factors. Nonwhite patients were more likely to watch ≥2 hours of television per day (78% vs 56%), to report exercising ≤1 time per week (35% vs 21%), and to drink ≥1 sugary drink daily (27% vs 13%).

CONCLUSION. Although patients reported good medication and monitoring adherence, they also reported poor diet and exercise habits and multiple barriers. Nonwhite race was significantly associated with poorer glycemic control even after adjusting for covariates. This may, in part, be related to disparities in lifestyle behaviors. Additional studies are indicated to further assess self-management behaviors and potential racial disparities in adolescents with type 2 diabetes.

Key Words: type 2 diabetes • adolescents • self-management • disparities

Abbreviations: T2DM—type 2 diabetes • T1DM—type 1 diabetes • CDP—Children's Diabetes Program • A1C—glycated hemoglobin

Accepted Sep 14, 2007.