Delay discounting and parental monitoring in adolescents with poorly controlled type 1 diabetes

Abstract

In a sample of adolescents with poorly controlled type 1 diabetes, this study examined if delay discounting, the extent to which individuals prefer immediate over delayed rewards, was associated with severity of non-adherence and poor glycemic control, and if parental monitoring of diabetes management moderated those associations. Sixty-one adolescents (Mage=15.08years, SD=1.43) with poorly controlled type 1 diabetes completed a delayed discounting task and an HbA1c blood test. Adherence was assessed via self-monitoring of blood glucose (SMBG) data from adolescents’ glucometers. Parents completed a parental monitoring questionnaire. Greater delay discounting was associated with higher HbA1c, but not SMBG. Direct parent observation of diabetes tasks, but not indirect parental monitoring, moderated the link between greater delay discounting and higher HbA1c, with higher direct parent observation buffering the link between greater discounting and poorer glycemic control. Delay discounting may be a target for future interventions to improve HbA1c in youth with type 1 diabetes.

Time preferences, diabetes self‐management behaviours and outcomes: a systematic review

“…Five additional articles were excluded after full-text review; three did not explicitly elicit time preferences, one lacked a diabetes-related outcome assessment, and one lacked a subgroup analysis of people with diabetes. A total of 12 articles [34][35][36][37][38][39][40][41][42][43][44][45] were included ( Table 1). Three studies analysed both time-consistent and time-inconsistent preferences [38,40,45], three studies solely analysed time-inconsistent preferences [34,35,39] and six studies did not explicitly define a time preference model [36,38,[41][42][43][44].…”

“…A total of 12 articles [34][35][36][37][38][39][40][41][42][43][44][45] were included ( Table 1). Three studies analysed both time-consistent and time-inconsistent preferences [38,40,45], three studies solely analysed time-inconsistent preferences [34,35,39] and six studies did not explicitly define a time preference model [36,38,[41][42][43][44]. Half of the studies estimated continuous discount rates [34,35,37,39,40,45], while the other half used ordinal measures [36,38,[41][42][43][44].…”

“…Three studies analysed both time-consistent and time-inconsistent preferences [38,40,45], three studies solely analysed time-inconsistent preferences [34,35,39] and six studies did not explicitly define a time preference model [36,38,[41][42][43][44]. Half of the studies estimated continuous discount rates [34,35,37,39,40,45], while the other half used ordinal measures [36,38,[41][42][43][44]. Measured outcomes across studies included self-care activities, such as taking medication, exercising and eating a healthy diet, and biomedical outcomes such as HbA 1c and diabetes-related complications.…”

“…Measured outcomes across studies included self-care activities, such as taking medication, exercising and eating a healthy diet, and biomedical outcomes such as HbA 1c and diabetes-related complications. Eleven studies [34][35][36][37][38][39][40][41][42][43][44] used cross-sectional data; of these, one also used panel data [36] and one study used panel data alone [45]. Two studies included data on insulin pump use [34,35]; however, one study reported only the proportion of participants using an insulin pump [35]; the other study included time preferences and insulin pump use in the same multivariate models but did not report interaction analyses [34].…”

“…All but two studies examining associations between time preferences and diabetes self‐care activities found that higher discount rates were associated with less diabetes‐related self‐care . With a single exception , the same negative relationship was observed between time preferences and HbA 1c , while studies of diabetes complications had mixed findings . The mechanism behind the association between time preferences and HbA 1c is unclear.…”