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Journal of Diabetes Research
Volume 2016, Article ID 3159103, 6 pages
Research Article

Low Self-Confidence and Diabetes Mismanagement in Youth with Type 1 Diabetes Mediate the Relationship between Behavioral Problems and Elevated HbA1c

1Department of Medical Psychology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
2EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
3Department of Pediatrics, VU Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, Netherlands
4Department of Medical Psychology, Academic Medical Center (AMC), Meibergdreef 9, 1100 DD Amsterdam, Netherlands

Received 10 December 2014; Revised 6 May 2015; Accepted 7 May 2015

Academic Editor: S. K. Mattoo

Copyright © 2016 Minke M. A. Eilander et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Previous studies indicated an association between behavior problems (internalizing, externalizing) and glycemic control (HbA1c) in youth with type 1 diabetes (T1D). The aim of this study is to examine if this association is mediated by self-confidence and mismanagement of diabetes. Methods. Problem behavior was assessed with the Strengths and Difficulties Questionnaire. Mediating variables were assessed using the Confidence in Diabetes Self-Care-Youth and Diabetes Mismanagement Questionnaire. HbA1c was derived from hospital charts. Bootstrap mediation analysis for multiple mediation was utilized. Results. 88 youths with T1D, age 11–15 y, participated. The relation between both overall problem behavior and externalizing behavior problems and HbA1c was mediated through confidence in diabetes self-care and mismanagement (  path; point estimate = 0.50 BCa CI 95% 0.25–0.85;   path; point estimate = 0.73 BCa CI 95% 0.36–1.25). Conclusions. Increased problem behavior in youth with T1D is associated with elevated HbA1c and mediated by low self-confidence and diabetes mismanagement. Screening for problem behavior and mismanagement and assisting young patients in building confidence seem indicated to optimize glycemic control.