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Parent--Adolescent Dyadic Diabetes Distress: Associations With Alc and Diabetes-Related Strengths.

Type 1 diabetes (T1D) is challenging both in the daily demands of the diabetes regimen and in the complex emotions associated with the condition. Youth with T1D require support to manage emotional distress and promote resilience. Diabetes distress refers to normative negative emotions related to the burden of daily self-care for T1D (Fisher et al., 2010). About one third of youth with T1D and one fourth of parents of youth with T1D experience elevated diabetes distress, and elevated distress is associated with worse adherence and glycemic control (Anderson et al., 2009; Hagger, Hendrieckx, Sturt, Skinner, & Speight, 2016), increased family conflict (Anderson et al., 2009), and decreased perceptions of self-efficacy (Law, Walsh, Queralt, & Nouwen, 2013; Nouwen, Urquhart Law, Hussain, McGovern, & Napier, 2009). Higher parent distress contributes to lower parent perception of adolescent self-efficacy (Law et al., 2013), which may hinder youth engagement in self-care. Distress is also associated with higher levels of disengagement in both adolescents and their parents (Jaser, Linsky, & Grey, 2014; Jaser, Patel, Xu, Tamborlane, & Grey, 2017). Less caregiver engagement and lower youth perception of caregiver involvement also contribute to worse diabetes outcomes (Hilliard et al., 2013; Vesco et al., 2010).

Although perceptions of diabetes distress have shown independent effects on diabetes-related outcomes, such as Alc and psychosocial functioning, interactive effects and associations of reporter congruence/incongruence among family members have not been fully investigated. It is common for members of a family to hold discrepant perceptions of the same constructs (e.g., conflict, distress; De Los Reyes et al., 2015; Ohannessian, Lerner, Lerner, & von Eye, 2000) and likely that response patterns among parents and youth may relate to outcomes differently than singular reports. Prior work examining adolescent-parent dyads recommends incorporating reports by individual respondents as well as considering the dyadic response on outcomes of interest (Bogensch-neider & Pallock, 2008). One study shows that adolescent-reported general distress was lower when there was adolescent-parent reported congruence on high family routines and low family chaos (Human, Dirks, DeLongis, & Chen, 2016). Discordance in dyadic reports was associated with higher adolescent distress when the adolescent reported fewer routines and higher chaos than the parent. In the diabetes literature, greater concordance between youth with T1D and their parents regarding higher family cohesion as well as lower diabetes-related family conflict is associated with better glycemic control and higher quality of life (Anderson et al., 2009; Laffel et al., 2003; Miller & Drotar, 2003; Rybak et al., 2017). Parent and adolescent reported diabetes distress likely differentially impact glycemic control, and the degree of congruence or incongruence in their individual reports may represent a third dimension of influence. Investigation of dyadic congruence/incongruence between adolescents and their parents on diabetes distress and association with glycemic control has not been evaluated and would meaningfully contribute to understanding the links between psychosocial functioning and medical outcomes.

Negative family interactions are associated with distress around diabetes and likely impact youths' sense of resilience and perceived strengths in diabetes care. Diabetes resilience, in contrast to distress, refers to self-perceptions regarding competence in daily management skills, experiencing positive quality of life, and achieving positive health outcomes (Hilliard, Harris, & Weissberg-Benchell, 2012). Diabetes strengths, including supportive family communication, disease management effectiveness, and positive problem-solving facilitate diabetes resilience (Hilliard et al., 2012; Hilliard, McQuaid, Nabors, & Hood, 2015) and can be defined as "adaptive processes, behaviors, and attitudes, that facilitate achievement of resilient outcomes" (Hilliard, Iturralde, Weissberg-Benchell, & Hood, 2017, p. 2). Diabetes strengths are associated with lower levels of distress and better Alc (Hilliard et al., 2017). Diabetes strengths are inversely associated with diabetes-related family conflict and positively associated with increased diabetes self-care and general reports of resilience (Hilliard et al., 2017). The concept of diabetes strengths is a novel and upcoming area of research interest and impacts self-care behaviors and glycemic control. Further understanding of the interplay of diabetes distress between parents and adolescents on perceived diabetes strengths is warranted as a means of furthering understanding resilience in this population.

Diabetes-related distress in families may be differentially associated with outcomes depending on who is demonstrating increased distress in the dyad (e.g., parent, adolescent, or both). Differences in diabetes distress across adolescents and their parents may influence medical and psychological outcomes; however, it is unclear how parent-reported and adolescent-reported distress function together to influence outcomes. The aim of the present study was to examine how concordant and discordant reports of distress between adolescents with T1D and their parents influence both glycemic control and adolescents' perceptions of their strengths in managing diabetes. We hypothesize that when both adolescents and their parents experience heightened diabetes distress, relative to when both members of the dyad experience lower levels of diabetes distress, glycemic control will be worse and adolescents will perceive fewer diabetes strengths. It is unclear how Alc and diabetes strengths are affected when one member (adolescent or parent) is demonstrating higher distress than the other. Understanding how levels of diabetes-specific emotional distress in adolescent/parent dyads are associated with medical and other psychosocial outcomes may contribute to more informed and tailored psychological strategies to best support families living with diabetes.

Method

Participants

Youth recruited for this study were between the ages of eight and 18 years, had T1D, and were planning to attend a diabetes summer camp. Data for the current analyses stem from assessment occurring approximately one month prior to camp and only include adolescents aged 12 to 18 years old and their parents. Sample originates from the second year of a larger study examining psychosocial outcomes of diabetes camps (Weissberg-Benchell & Rychlik, 2017). All study-related materials and procedures were approved by the Institutional Review Board at the Ann & Robert H. Lurie Children's Hospital of Chicago in Chicago, Illinois. Informed consent and assent were obtained from all participants. To participate, youth had to have a parent willing to consent to the study and complete study measures, and families had to be fluent in English. Camp directors sent e-mails and letters to families enrolled in their respective diabetes camps inviting them to participate in the study and directing them to the study website where they could express interest and consent to participation. Data collection was primarily completed via a secure online survey portal where youth and their parents were able to log in using a link emailed to them by study staff. After viewing the website, 2,419 campers and their parents completed consent. Cross-sectional data were available for 1,216 adolescents and their parents, attending one of 44 diabetes camps across the United States, representing 114 separate camp sessions.

Measures

Demographics. Parents were asked to complete a form asking for information regarding their adolescent's age, race/ethnicity, family income, and diabetes variables. Parents also self-reported their child's most recent hemoglobin Alc, which was used as a proxy for glycemic control in the present analyses.

Diabetes distress. Adolescents completed the Problem Areas In Diabetes-Teen version (PAID-T) for youth aged 12 to 18 years (Weissberg-Benchell & Antisdel-Lomaglio, 2011). Parents completed the Problem Areas In Diabetes for Parents of Teens (P-PAID-T; Weissberg-Benchell, Hood, & Antisdel-Lomaglio, 2014). Each self-report measure consists of 26 items assessing the respondent's own distress in living with diabetes. Each item is rated on a 6-point Likert scale from 1 (not a problem) to 6 (serious problem) depending on how much distress the respondent faced over the past month on a variety of diabetes-related domains (e.g., feeling overwhelmed by diabetes, concerned about food and eating, concerns over blood sugar fluctuations). These measures demonstrated good reliability with Cronbach's alpha = .95 for adolescent and parent reports.

Diabetes strengths. Adolescents completed the 12-item Diabetes Strengths and Resilience (DSTAR) self-report measure (Hilliard et al., 2017). Items are designed to assess the adolescent's perception of their ability to manage the demands of diabetes, to adapt when diabetes appears unpredictable, and to seek social support from family, friends, and health care providers. Youth rate each item on a 5-point Likert scale from 1 (never) to 5 (almost always) with respect to how much each statement applies to them (e.g., "good at figuring out what to do for my diabetes," "I can always ask for help with my diabetes"). Internal reliability of this measure was good, with Cronbach's alpha = .78.

Data Analysis

The association between demographic variables and diabetes distress, parent-reported Alc, and diabetes strengths were assessed using correlation and independent samples t tests as appropriate. Polynomial regressions with response surface analysis (RSA; Shanock, Baran, Gentry, Pattison, & Heggestad, 2010) were used to examine the independent and interactive associations of adolescent and parent reports of diabetes distress (PAID-T and P-PAID-T) on parent-reported hemoglobin Alc and adolescent-reported diabetes strengths (DSTAR). Two quadratic equations (one for Alc and one for DSTAR) were used to fit a second-order polynomial regression as follows: Y = [b.sub.0] + [b.sub.1] (PAID-T score) + [b.sub.2] (P-PAID-T score) + [b.sub.3] (PAID-T by P-PAID-T interaction) + [b.sub.4] (PAID-T score squared) + [b.sub.5] (P-PAID-T score squared). Slope and curvature parameters, using RSA for the resulting response surface pattern from the quadratic regressions, were calculated to represent the interactive association of concordance of PAID-T and P-PAID-T with each outcome (parameter estimates [a.sub.1] and [a.sub.2]); similarly, associations of disagreement on PAID-T and P-PAID-T with each outcome were also calculated (parameter estimates [a.sub.3] and [a.sub.4]). PAID-T and P-PAID-T diabetes distress measures were converted to z-scores using each measure's sample means and standard deviations to increase model inter-pretability. Graphical displays for each analysis were provided to illustrate how parameters estimate the association between report concordance/discordance and primary outcomes. The same analyses were repeated to determine independent and interactive effects of PAID-T and P-PAID-T on primary outcomes while controlling for statistically significant demographic predictors of outcome. Any demographic characteristic demonstrating a significant correlation/t test with Alc or diabetes strengths was included in the respective regression controlling for demographics on that outcome. This was completed to determine the robustness of the associations of dyadic reports of diabetes distress on Alc and diabetes strengths. Statistical significance for all analyses was p < .05.

Results

Sample Characteristics and Missing Data Analyses

Of the 1,216 adolescents and their parents who consented, complete PAID-T and P-PAID-T were available for 977 and 1,117 respondents, respectively, with 906 adolescent-parent dyads having complete PAID-T/P-PAID-T data. Of these 906 dyads, 860 had a value for Alc and 864 had complete DSTAR data. Demographic comparisons were made between dyads with complete data and the 311 (25.6%) families who had missing parent and/or adolescent-reported PAID measures. More minority youth were missing PAID measures (14.7% were of minority status in the missing dataset vs. 9.5% minority youth in the complete dataset, p < .05). There were no demographic differences on Alc or diabetes strengths for those missing these data compared to those with complete data. There were also no demographic subsample differences for those missing Alc or DSTAR data compared to those with complete data.

Table 1 presents the demographic information for the primary sample of 906 adolescents and parents with complete PAID-T/P-PAID-T data. Table 2 presents means, standard deviations, and correlations among continuous variables collected in this study. The mean age of participants was 14.40 years, 57.6% were female and 90.5% were non-Hispanic White. Most parent respondents were mothers. There was a nearly normally distributed range of family incomes, with median annual income around $100,000. Time from diagnosis of T1D ranged from 1 to 17 years with mean around 7 years. Nearly three-quarters of adolescents used insulin pumps, and 12.9% used continuous glucose monitoring (CGM).

Demographic Differences for Diabetes Distress, Alc, and Diabetes Strengths

Higher adolescent-reported diabetes distress was associated with older age (p = .012), longer diabetes duration (p = .025), being female (p < .001), and lower family income (p < .001). Lower distress was associated with pump use (p < .001).

Higher parent-reported diabetes distress was associated with child racial minority status (p = .028) and lower family income (p < .001). Lower distress was associated with pump use (p = .002).

Higher Alc was associated with older age (p = .001), longer diabetes duration (p = .013), racial minority status (p < .001), and lower family income (p < .001). Lower Alc was associated with both pump and CGM use (p < .001 and p = .001, respectively). Greater adolescent-perceived diabetes strengths were associated with pump (p < .001) and CGM use (p = .015). Alc was positively associated with parent-and teen-reported distress and inversely associated with diabetes strengths, with small-moderate correlations (see Table 2).

Regression and RSA of Diabetes Distress on Alc and Diabetes Strengths

Results demonstrated significant overall explained variance for both Alc, F(5, 859) = 23.74, p < .001, adjusted [R.sup.2] = 0.116, and diabetes strengths, F(5, 863) = 40.99, p < .001, adjusted [R.sup.2] = 0.187. Table 3 provides regression coefficients for both outcomes. Figure 1 provides a graphic illustration of the analyses to aid in interpretation of tabulated data.

Alc was lower when distress was concordantly low and higher when distress was concordantly high, with significant association of concordance (a, = 0.609). Higher Alc was reported when distress was higher for parents and lower for adolescents compared to low-parent/high-adolescent distress as demonstrated by a significant association of discordance ([a.sub.3] = 0.273). Relative independent effects of parent-reported distress were higher than adolescent-reported distress (i.e., higher main effect of parent-reported distress than adolescent-reported distress on Alc). There were no significant quadratic trends of distress on Alc.

Adolescents reported greater diabetes-related strengths when distress was concordantly low and fewer strengths when distress was concordantly high with significant association of concordance (a, = -2.950). Greater strengths were reported when distress was higher for parents and lower for adolescents compared to low-parent/high-adolescent distress as demonstrated by a significant association of discordance ([a.sub.3] = 1.696). Relative independent effects of adolescent-reported distress were higher than parent-reported distress. There were no significant quadratic trends of distress on diabetes strengths.

Regression and RSA of Distress on Outcomes While Controlling for Demographic Covariates

Regression analyses of Alc and diabetes strengths on distress dyad groups controlling for statistically significant demographic differences were completed (see Table 4). Included demographic variables in these regressions were based on statistically significant correlation/t test analyses with each dependent variable as reported above. Because diabetes duration was highly correlated with age, it was not included in the model predicting Alc despite being statistically significant. Age was chosen over duration as it had a slightly higher association with Alc. Including age and duration simultaneously in the model would have increased multicollinearity and violation of regression assumptions.

Age, racial minority status, family income, pump use, and CGM use were entered into a regression model predicting Alc along with parent- and adolescent-reported distress, their interaction, and the squared terms of each. The overall model was significant, F(10, 618) = 13.57, p < .001, adjusted [R.sup.2] = 0.167. Age, annual income, and CGM use remained significant covariates in the model. Associations of concordance and discordance changed minimally and remained statistically significant compared to the model without covariates, demonstrating robustness of the dyadic effect of parent-adolescent distress on Alc.

Pump use and CGM use were entered as predictors of diabetes strengths along with parentand adolescent-reported distress, their interaction, and the squared terms of each. The overall model was significant, F(7, 813) = 33. 18, p < .001, adjusted [R.sup.2] = 0.216. Pump use remained a significant covariate in this model, but CGM use did not. Associations of concordance and discordance changed minimally and remained statistically significant compared to the model without covariates, demonstrating robustness of the dyadic effect of parent-adolescent distress on diabetes strengths.

Discussion

The aim of the present study was to examine how concordant and discordant reports of distress between adolescents with T1D and their parents are associated with Alc and adolescents' perceptions of their strengths in managing diabetes. To the authors' knowledge, this is the first study to examine the association of parent-adolescent dyadic diabetes distress responses on diabetes outcomes. Findings supported initial hypotheses. When both adolescents and their parents experience heightened diabetes-specific emotional distress (concordantly high), the adolescent experiences higher Alc and lower perceived diabetes strengths relative to concordantly lower reports. Examination of outcomes related to discordant reports of distress within adolescent-parent dyads was exploratory. Results demonstrated a statistically significant association of discordant reports of distress (higher-parent/lower-teen vs. lower-parent/higher-teen) for Alc and for diabetes strengths. When parents were more distressed than their adolescents, the adolescents had higher parent-reported Alc. The opposite pattern was observed for diabetes strengths. When adolescents reported higher distress than their parents, adolescent-perceived diabetes strengths were lower. Associations of concordance and discordance were robust when controlling for significant demographic differences for respective outcomes.

Results suggest that interventions aimed at minimizing diabetes-related distress should target both adolescents and their caregivers. Previous literature demonstrates associations between lower diabetes strengths, lower diabetes efficacy, and lower adherence (Hilliard et al., 2017; Law et al., 2013). It is possible that lower perceived diabetes strengths is contributing to lower adherence, which may be contributing to higher Alc. However, the current cross-sectional analyses preclude our ability to examine these sequential relationships. Alternatively, it is plausible that adolescents with lower Alc, either due to biological mechanisms and/or stricter regimen adherence, may have more perceived diabetes strengths and, consequently, lower distress in the family. Future longitudinal analyses investigating these associations would be useful in understanding pathways associated with glycemic control.

Previous family-based intervention studies have not reported on parent diabetes distress as a treatment outcome, instead focusing on adolescent psychological variables, increasing parental monitoring, treatment adherence, family communication/conflict, and glycemic control (Anderson, Brackett, Ho, & Laffel, 1999; Hilliard, Powell, & Anderson, 2016; Wysocki et al., 2008). Consideration of parent distress, particularly given its association with Alc in the current study, is warranted in future intervention studies of adolescents and their families. Family-based, diabetes-specific psychosocial interventions may be useful when both the parent and adolescent are experiencing higher distress and may mediate existing treatment associations with decreased family conflict, improved family communication, and increased collaborative problem-solving, all of which can influence Alc and diabetes strengths (Hilliard et al., 2016; Wysocki et al., 2006).

A developmental approach to psychosocial interventions with adolescents should be considered. International guidelines for the psychological care of youth with T1D recommend dynamic and open negotiation of responsibilities between adolescents and their caregivers as adolescents mature. Adolescents are expected to assume greater responsibility for diabetes management, but with ongoing and collaborative parental involvement and support (Delamater et al., 2014). Research has shown that adolescents with lower social and cognitive maturity have more problems with diabetes management (Wysocki et al., 1996). Balancing the push for autonomy with appropriate caregiver scaffolding and support is essential to optimized diabetes outcomes.

Interventions that teach adolescents coping skills in both problem-solving and emotion regulation with diabetes focus are shown to minimize the severity of distress and reduce Alc (Hagger et al., 2016; Hilliard et al, 2016). Such interventions may occur individually or in a peer-group format (Cook, Herold, Edidin, & Briars, 2002; Grey, Boland, Davidson, Li, & Tamborlane, 2000). Increased diabetes distress and difficulties with regimen adherence (and consequently worse glycemic control) have been attributed to negative peer reactions to diabetes self-care (Hains et al., 2007; Helgeson, Siminerio, Escobar, & Becker, 2008). From the current analyses, assisting with adolescent diabetes distress, and improving adolescents' abilities to engage in social problem-solving and assertive communication about diabetes, may also positively impact perceived diabetes strengths.

Limitations of the current study should be noted. First, Alc was based on parent-report and not based on chart review or direct lab results. Because this was a national study and due to scope of the project, the investigators did not have the resources to collect lab data or to procure medical chart data. Future work investigating the dyadic relationships of diabetes distress on Alc based on direct lab work may be useful. Second, findings suggest that adolescent-reported distress more strongly influences

These findings underscore the importance of evaluating psychosocial outcomes such as diabetes distress in families since there are direct associations with medical outcomes (Alc) and perceived strengths in diabetes management. These findings also emphasize the importance of analyzing both youth-perceived distress and caregiver distress since there are interactive outcome associations when reports are concordant versus discordant. Diabetes has broad family effects, and it is important to consider both parent and youth perspectives. Measuring diabetes distress in both adolescents and their parents is necessary given that higher distress is associated with worse glycemic control and given that parental involvement is necessary for optimal diabetes management.

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Anthony T. Vesco, PhD Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois

Marissa A. Feldman, PhD, Meredyth A. Evans, PhD, and Jill Weissberg-Benchell, PhD Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, and Northwestern University

This article was published Online First July 12, 2018.

Anthony T. Vesco, PhD, Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Marissa A. Feldman. PhD, Meredyth A. Evans. PhD. and Jill Weissberg-Benchell. PhD. Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, and Feinberg School of Medicine, Northwestern University.

Marissa A. Feldman, PhD, is now at Johns Hopkins All Children's Hospital, St. Petersburg, Florida, since the time of publication of this article.

This research was supported in part by a grant from the Helmsley Charitable Trust Foundation.

Correspondence concerning this article should be addressed to Anthony T. Vesco. PhD, Department of Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Mailbox 10A, Chicago, IL 60611. E-mail: avesco@luriechildrens.org

Received August 12, 2017

Revision received February 26, 2018

Accepted March 7, 2018

http://dx.doi.org/10.1037/fsh0000358
Table 1 Demographic Characteristics of Sample (N = 906 Dyads)

Characteristic            n     %

Gender: Female          518  57.6
Youth race
 White                  784  90.5
 Black/African           36   4.2
 American
 Latino                  38   4.4
 Native American          5    .6
 Asian                    3    .3
Caregiver relationship
 Mother                 758  89.8
 Father                  76   9.0
 Grandmother              7    .8
 Grandfather              1    .1
 Other guardian           2    .2
Family income
 <$25,000                69   9.1
 $26-50,000             133  17.5
 $51-75,000             114  15.0
 $76-100,000            126  16.6
 $101-125,000           116  15.3
 $126-150,000            64   8.4
 $151-175,000            44   5.8
 >$ 175,000              93  12.3
 Use pump               673  74.5
 Use CGM                110  12.9

Note. CGM = continuous glucose monitoring.

Table 2 Correlations, Means, and Standard Deviations of Continuous
Measures

Variable               1              2             3

1. Age                 14.40(1.49)
2. Diabetes duration     .913         7.18 (2.74)
3. Alc                   .097          .087          7.92 (1.59)
4. PAID parent report   -.035         -.033           .332
5. PAID teen report      .085          .077           .240
6. DSTAR teen report    -.065         -.054          -.229

Variable               4              5              6

1. Age
2. Diabetes duration
3. Alc
4. PAID parent report  78.84 (24.76)
5. PAID teen report      .447         73.60 (27.00)
6. DSTAR teen report    -.276          -.426         37.06 (6.05)

Note. PAID = Problem Areas in Diabetes measure; DSTAR = Diabetes
Strengths and Resilience self-report measure. Significant correlations
(p < .05) are in bold typeface. Overall sample M (SD) are presented on
the diagonal for each variable.

Table 3 Polynomial Regression Analyses With Response Surface Analysis
(RSA) for Distress Predicting Alc and DSTAR Outcomes

                                                        Alc
Variable                                   Coefficient  SE    p-value

Intercept (bO)                             7.858        .081  <.001
Adolescent diabetes distress (PAID-T; bl)   .168        .060   .005
Parent diabetes distress (P-PAID-T; b2)     .441        .058  <.001
PAID-T X P-PAID-T interaction (b3)         -.005        .069   .940
PAID-T squared term (b4)                    .037        .053   .480
P-PAID-T squared term (b5)                  .022        .051   .666
Linear association of concordance (al)      .609        .063  <.001
Quadratic association of concordance (a2)   .054        .062   .384
Linear association of discordance (a3)      .273        .100   .006
Quadratic association of discordance (a4)   .065        .134   .630

                                                        DSTAR
Variable                                   Coefficient  SE    P value

Intercept (bO)                             37.054       .288  <.001
Adolescent diabetes distress (PAID-T; bl)  -2.323       .217  <.001
Parent diabetes distress (P-PAID-T; b2)     -.627       .212   .003
PAID-T X P-PAID-T interaction (b3)          -.182       .236   .441
PAID-T squared term (b4)                     .185       .189   .329
P-PAID-T squared term (b5)                  -.068       .179   .704
Linear association of concordance (al)     -2.950       .229  <.001
Quadratic association of concordance (a2)   -.065       .225   .773
Linear association of discordance (a3)      1.696       .363  <.001
Quadratic association of discordance (a4)    .299       .455   .512

Note. PAID-T = Problem Areas In Diabetes-Teen version; P-PAID-T =
Problem Areas In Diabetes for Parents of Teens. Coefficient refers to
the regression coefficient of the second-order polynomial. All
regression terms and specified parameter name as discussed in data
analytic plan are presented. PAID-T and P-PAID-T were standardized
based on reporter sample mean and standard deviation.

Table 4 Polynomial Regression With Response Surface Analysis of
Distress Predicting Alc and DSTAR Controlling for Demographics

                                                        Alc
Variable                                   Coefficient  SE    p value

Intercept (bO)                             7.887        .139  <.001
Adolescent diabetes distress (PAID-T; bl)   .115        .069   .099
Parent diabetes distress (P-PAID-T; b2)     .443        .067  <.001
PAID-T X P-PAID-T interaction (b3)          .055        .082   .498
PAID-T squared term (b4)                    .073        .062   .241
P-PAID-T squared term (b5)                 -.038        .059   .514
Linear association of concordance (al)      .558        .071  <.001
Quadratic association of concordance (a2)   .090        .071   .208
Linear association of discordance (a3)      .328        .116   .005
Quadratic association of discordance (a4)  -.021        .160   .896
Age                                         .095        .038   .014
Racial minority                             .206        .204   .312
Annual family income                       -.090        .027   .001
Pump use                                   -.031        .133   .817
CGM use                                    -.391        .171   .023

                                                        DSTAR
Variable                                   Coefficient   SE    p-value

Intercept (bO)                             36.005        .454  <.001
Adolescent diabetes distress (PAID-T; bl)  -2.372        .221  <.001
Parent diabetes distress (P-PAID-T; b2)     -.605        .215   .005
PAID-T X P-PAID-T interaction (b3)          -.224        .237   .345
PAID-T squared term (b4)                     .241        .189   .203
P-PAID-T squared term (b5)                   .001        .180   .995
Linear association of concordance (al)     -2.977        .232  <.001
Quadratic association of concordance (a2)    .018        .226   .935
Linear association of discordance (a3)      1.767       4.794  <.001
Quadratic association of discordance (a4)    .466        .457   .308
Age                                        --           --      --
Racial minority                            --           --      --

Annual family income                       --           --      --
Pump use                                    1.241        .441   .005
CGM use                                     1.004        .557   .072

Note. PAID-T = Problem Areas In Diabetes-Teen version; P-PAID-T =
Problem Areas In Diabetes for Parents of Teens: Coefficient = the
regression coefficient of the second-order polynomial. All regression
terms and specified parameter name as discussed in data analytic plan
are presented. PAID-T and P-PAID-T were standardized based on reporter
sample mean and standard deviation. Racial minority variable was dummy
coded with being White, non-Hispanic as the reference group and a being
a racial minority coded as one. Similarly, pump use was dummy coded
relative to multiple daily-injections, and continuous glucose
monitoring (CGM) use was dummy coded relative to using a standard blood
glucose meter. Age and annual income were mean-centered. The em-dash
indicates that variable was not significantly associated with outcome
and not included in model.
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Article Details
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Author:Vesco, Anthony T.; Feldman, Marissa A.; Evans, Meredyth A.; Weissberg-Benchell, Jill
Publication:Families, Systems & Health
Article Type:Report
Date:Sep 1, 2018
Words:5867
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