Hemoglobin A1c (HbA1c) levels have been shown to worsen in adolescence and to be related to long-term diabetes complications. Although categories of diabetes control (e.g., ideal, satisfactory, and poor) are routinely used in clinical practice, research has not fully explored whether these categories meaningfully distinguish between different self-management characteristics. Kichler and colleagues examined potential differences in self-management characteristics for adolescents and their caregivers for three different categories of diabetes control (e.g., ideal, satisfactory, and poor control). A total of 69 adolescents (35 M/34 F) with type 1 diabetes mellitus (T1DM) (aged 12-17 yr) and their caregivers completed questionnaires of readiness to change the balance of responsibility for diabetes tasks, family responsibility in diabetes management, and self-efficacy for diabetes. A medical record review yielded demographic information, most recent HbA1c level, and health care utilization over the past year. Participants in the three different categories of diabetes control demonstrated no significant differences on measures of self-management characteristics. Maternal caregivers from the satisfactory control category and youths in the poor control category demonstrated the most consistent responses across various self-management characteristics.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that adolescents classified in different categories of glycemic control may not be as different in their self-management characteristics as was presumed. Moreover, associations among self-management characteristics were not universal across responders. Therefore, individual assessments of adolescents' and caregivers' self-management characteristics need to occur independent of the youths' membership in a certain category of diabetes control.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study nicely demonstrated the need to tailor self-management for individual patients. The tailoring will likely not be that major, but each of us deserves a program that best fits our needs and chronic conditions.

JC Kichler et al. Exploring self-management characteristics in youths with type 1 diabetes mellitus: does membership in a glycemic control category matter? Pediatric Diabetes, February 7, 2010.