The goal of this research was to develop and evaluate measures of adolescent diabetes management self-efficacy and outcome expectations that reflect developmentally relevant, situation-specific challenges to current diabetes regimens. Self-efficacy for diabetes management, expected outcomes of adherence, adherence to the diabetes regimen, and glycemic control were assessed in 168 adolescents (ages 10-16 years) with type 1 diabetes. Factor analyses indicated a single scale for self-efficacy and two distinct factors representing positive and negative outcome expectations. Reliability and predictive validity of the new scales were supported. In regression analyses, self-efficacy and the interaction of self-efficacy with expectations of positive outcomes were significantly associated with diabetes self-management adherence and glycemic control in older adolescents. The effect of self-efficacy was greatest when adolescents had stronger beliefs in the beneficial outcomes of adherence. These brief measures can be used to identify youths at risk of poor diabetes self-management. Interventions targeting self-efficacy may lead to improved diabetes self-management.

OBJECTIVE -The purpose of this study is to evaluate two updated measures of diabetes regimen adherence. The Diabetes Self-Management Profile (DSMP) is a widely used, structured interview. Limitations include a substantial interviewer and respondent time burden and the need for well-trained interviewers to use appropriate prompts and score the open-ended responses. The Diabetes Behavior Rating Scale (DBRS) is a self-administered, fixed-choice survey.RESEARCH DESIGN AND METHODS -Both measures were administered to 146 youth with type 1 diabetes (aged 11-18 years) and their parents. Items were added to the DBRS to allow for both flexible and conventional regimens, and the DSMP was modified to use standardized wording across items, accommodate flexible regimens, and permit administration by nonmedical interviewers.RESULTS -Both measures had good evidence of internal consistency (for the DSMP: parent 0.75 and youth 0.70; for the DBRS: parent 0.84 and youth 0.84). Scores on the DSMP and the DBRS were significantly related (r ϭ 0.72 for parents and 0.74 for youth). There was moderate agreement between parent and youth (DSMP, r ϭ 0.51; DBRS, r ϭ 0.48). The measures were correlated with HbA 1c for both parent (DSMP, r ϭ Ϫ0.35; DBRS, r ϭ Ϫ0.35) and youth (DSMP, r ϭ Ϫ0.36; DBRS, r ϭ Ϫ0.34) reports.CONCLUSIONS -Both measures exhibit good psychometric properties and good criterion validity but varied in terms of respondent and interviewer burden, issues that should be considered in selecting assessment procedures. Diabetes Care 29:2263-2267, 2006L ong-term complications of insulindependent diabetes (type 1 diabetes) include higher morbidity and mortality from retinopathy, nephropathy, neuropathy, and cardiovascular disease (1-4). There may be no minimum glycemic threshold for the reduction of longterm complications; long-term risk continues to decrease with HbA 1c (A1C) Ͻ8% accompanied by a lessgradual increase in the risk of hypoglycemia (5). Successful management of type 1 diabetes has been shown to reduce the frequency and severity of these long-term consequences; however, although intensive therapy may improve glycemic control, few families are able to maintain metabolic control within the recommended guidelines (1-6), and control appears to decrease during the adolescent years (7-12). To reduce potential longterm health effects, Cefalu (13) argues for lowering the pediatric glycemic goal Ͻ8% but recognizes that until we can improve diabetes management during adolescence, such a goal is meaningless.Diabetes self-management includes a variety of skills that must be performed daily: monitoring blood glucose, administering insulin, regulating diet and physical activity, and calculating appropriate care based on the results of these activities (14,15). In addition, the process requires adaptation to changing adolescent physiology and shifting parent and youth responsibilities while recognizing that the goals of diabetes management may be changing at the same time (15). Reliable and valid measures of adherence are essential fo...

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 ϭ 156) aged 10 -16 years and their parents were administered a modified version of the Diabetes SelfManagement 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 ϭ 0.47, P Ͻ 0.0001). A1C was 1.6% higher in the inadequate style group than in both other groups (P Ͻ 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. Diabetes Care 30:1107-1112, 2007S uccessful treatment of type 1 diabetes in adolescence rests heavily on the involvement of the young patients and their families. Evidence indicates that interventions that enhance adherence to the diabetes regimen improve adolescents' metabolic control (1,2). This in turn produces significant and long-lasting health benefits by reducing the risk of severe long-term complications and increasing life expectancy (3,4). Despite numerous technological advances, problems with adherence and metabolic control continue to be common and are exacerbated during the adolescent years (5-10). Thus, evaluating and improving diabetes self-management remains a critical issue in research and clinical practice.Many authors have noted that selfmanagement cannot be adequately defined as a static and unitary response to instructions given by health professionals. Instead it is multifaceted and involves sophisticated processes of day-to-day self-regulation (11-14). Optimal diabetes management requires a patient to maintain a delicate balancing act between insulin dose, food intake, and physical activity, guided by frequent blood glucose monitoring (14,15). Consistent with the notion of multidimensionality, adherence in different treatment areas has been found to be only weakly intercorrelated (11,12,16,17). Although parents and children might initially intend to follow the entire treatment protocol as recommended, eventu...

To determine the locus of opiate modulation of ACTH secretion, 11 normal subjects were given ovine corticotropin-releasing hormone (CRH) 30 min after receiving either placebo or morphine sulfate. Plasma ACTH, cortisol, arginine vasopressin (AVP), epinephrine, norepinephrine, and CRH were measured 30 min before and up to 150 min after CRH administration. Morphine blunted the ACTH response for the first 60 min and cortisol response for the first 90 min after CRH administration. Morphine did not lower arginine vasopressin or catecholamine levels. To determine whether morphine's effect on ACTH and cortisol was due to a direct action on the corticotroph cell, dispersed rat pituitary cells were perifused with medium containing 1 microgram/ml morphine sulfate or medium alone. Morphine had no effect on the ACTH response of these cells to 10 nM CRH pulses. Similarly, morphine had no effect on ACTH production by dispersed rat pituitary cells in monolayer culture in response to 90- and 180-min incubations with 5 nM CRH. We conclude that morphine blunts the early response of the pituitary gland to CRH in vivo. Based on the lack of a direct effect of morphine on rat pituitary cells in vitro, we postulate that morphine given in vivo may modulate the pituitary ACTH response to CRH through other suprapituitary factors.