Date of Award


Degree Type


Degree Name

Doctor of Philosophy


The relationship of psychosocial factors to glucose control in persons with Insulin Dependent Diabetes Mellitus (IDDM) is not clearly understood. The present study examined the effects of sources of stress and its mediators and moderators on glucose control in children with IDDM. Forty children with IDDM and their caretakers were followed for a period of six months with data collected at two 3 month intervals (phase 1 and phase 2). The primary caretaker and child provided ratings of sources of general and diabetes related stress. General and diabetes related social support, coping and behavior measures were collected as well as health history and demographic information. Glucose control was measured through an aggregated daily measure, glycosylated hemoglobin levels (GHB) and the number of hypoglycemic reactions.;The results indicated that the children in this study had more internal and external behavior problems than their nonchronically ill peers. It was not clear, however, if the caretakers rated their chronically ill children's behavior in a more negative light, or if the children did have elevated behavior problems relative to the normative sample.;The measures of glucose control were demonstrated to be complementary, rather than redundant indices, and were differentially sensitive to certain psychosocial factors within and across phases of the study. Sources of stress and supportive diabetes related behaviors reported by primary caretaker and child were associated with variability in daily glucose control within phases of the study. Across phases, primary caretaker stress predicted GHB levels; while the daily measure of glucose control predicted primary caretaker stress and nonsupportive diabetes related behaviors.;The age of the child proved to be an important factor in daily glucose control. The younger the child, the more variable the daily glucose control. In addition, there was a moderating effect of the age of the child on primary caretaker sources of stress in the prediction of later daily glucose control.;The across phase analyses revealed preliminary evidence to support the existence of a unidirectional causal relation, with daily glucose control predicting later sources of stress in the primary caretaker and nonsupportive diabetes related behavior. In addition, primary caretaker sources of stress predicted GHB levels. Further examination of the existence of a circular relationship between sources of stress and measures of glucose control (i.e., GHB and daily measure) is warranted.;Although the findings are preliminary, they underscore the importance of using more than one outcome measure when looking at the effects of psychosocial factors on glucose control. The differential sensitivity of the daily glucose measure to certain psychosocial factors was explained by the proposal that the effect of psychosocial factors does not cause a tonic change in glucose control, but rather produces fluctuations that were only reflected in the daily measures of glucose control. Clinical and research implications of the findings were discussed. The limitations of the present study were outlined and future research was proposed.



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