Subclinical biobehavioral factors, adherence to diabetes self-care, and glycemic control in Type 1 diabetes mellitus

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)


Clinical Psychology

First Committee Member

Barry E. Hurwitz, Committee Chair


Achieving glycemic control due to insulin treatment consequent to strict adherence to diabetes self-care behaviors greatly reduces the risk of long-term complications of Type 1 diabetes mellitus (DM-1). The primary purpose of this dissertation was to develop a conceptual model in adult men and women with DM-1 that includes psychosocial functioning, adherence to diabetes self-care behaviors, and glycemic control. The assessment of these interrelationships in persons with DM-1 without a history of major diabetes related complications, who have had the disease for a period of time but have had fairly good glycemic control would permit an understanding of these factors impacting glycemic control before potentially confounding disease complications and pathophysiology complicate their investigation. Therefore, in this study subjects were enrolled if their diagnosed DM-1 was established for a duration of at least 8 years but their glycemic control was at least in the fair to good range (i.e., HbA1c was 4 to 11%) and upon clinical examination were free of diabetes-related complications and neuropathies, although subjects who displayed minimal evidence of sensory neuropathy were included. Subjects were recruited from the Miami-Dade community as part of a study assessing the integrity of autonomic mediation of cardiovascular function in DM-1. The subjects were 45 Non-Hispanic White (53%), Hispanic (30%), and Black (17%) men (n = 21) and women (n = 24) and ranged in age from 18 to 55 years (mean +/- SD 34 +/- 8), with a mean +/- SD diabetes duration of 18 +/- 7 years, and mean +/- SD glycemic control of 7.5 +/- 2%. Psychosocial measures assessed depressive symptoms, adherence to DM-1 self-care behaviors, coping with DM-l, and both diabetes-specific and general perceived stress. Glycosylated hemoglobin and general health status were obtained as well.This study used hierarchical regression to test two theoretical mediation models suggested by prior research. Planned mediational analyses using a total adherence score did not indicate that adherence mediates the associations between either diabetes-specific stress or dysphoria with glycemic control. However, post-hoc exploratory analyses revealed that certain diabetes self-care behaviors may be mediators of these relationships. Specifically, greater diabetes-stress and dysphoria may be associated with diminished adherence to blood glucose testing and eating meals on time which, in turn, is negatively related with glycemic control. (Abstract shortened by UMI.)


Psychology, Behavioral; Health Sciences, Medicine and Surgery; Psychology, Clinical

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