Introduction Deteriorating type 1 diabetes management and control are common among adolescents, yet clinical evidence suggests that individual trajectories can vary. The aim of this study was to examine patterns and predictors of blood glucose monitoring (BGM) frequency and glycemic control (A1c). Methods Prospective data analysis spanning 18–24 months with 150 adolescent-parent pairs. Latent group-based trajectory modeling identified subgroups and determined medical, demographic, psychological, and family predictors of subgroup membership. Results Three subgroups emerged, representing diabetes management and control that is “meeting treatment targets” (40%; A1c at baseline= 7.4%, blood glucose monitoring (BGM) frequency at baseline = 4.8 checks/day) and two levels “not meeting targets”: “normatively similar” youth (40%; A1c = 9.2%, BGM frequency = 2.8 checks/day), and “high risk” youth (20%; A1c = 11.2%, BGM frequency = 2.9 checks/day). Subgroup membership was maintained over 18–24 months. There was minimal change across time, although only one-third met treatment targets. Older age, longer diabetes duration, ethnic minority status, unmarried caregiver status, insulin delivery via injections vs. CSII, greater depressive symptoms, negative affect about BGM, and diabetes-specific family conflict each predicted membership in a subgroup with poorer diabetes management and control. Conclusions Among the nearly two-thirds of adolescents with management and control that do not meet treatment targets, modifiable and non-modifiable factors may signal the need for prevention or intervention. Demographic and medical factors may call for proactive efforts to prevent deterioration, while psychological symptoms and family conflict signal opportunities for clinical intervention to promote improved diabetes management and control in adolescence.

Author conflict of interest appears to be prevalent among psychiatric clinical trials and to be associated with a greater likelihood of reporting a drug to be superior to placebo.

Recommendations for the use of, and the further refinement of, these suggested competencies are discussed.