Teens with Type 1 Diabetes: A Focus on Friendship

摘要 1型糖尿病是儿童中最常见的慢性疾病之一。1型糖尿病是一种 复杂的、劳动密集型的工作，因为必须全天监测血糖水平，监测饮食， 运动，注射胰岛素，并根据这些活动调整胰岛素。无法进行适当的自我- 护理行为是有问题的，因为不受控制的血糖会对患者造成短期和长期的威胁。 健康青春期的特点是一个发展时期，在这一时期，1型糖尿病青年面临 难以维持良好的血糖控制，部分原因是自我护理行为下降。大部分 针对这种下降的研究集中在家庭，但同伴关系是另一个重要的， 被忽视的青年社会环境。因此，本提案侧重于朋友发挥的作用 1型糖尿病患者的心理、行为和身体健康。我们有三个具体的 目的：（1）考察朋友整合和朋友冲突与心理幸福感的关系， 糖尿病的结果（自我护理行为，血糖控制）;（2）确定解释糖尿病的潜在机制， 朋友整合和朋友冲突与这些结果之间的联系;（3）考察未减轻的特质 圣餐（即，过度参与他人而忽视自我）作为朋友关系的调节者 整合和朋友冲突的结果，预测联系将更强的那些高的未减轻 圣餐我们假设，朋友间的冲突会导致心理压力的增加， 自我保健，未能讨论糖尿病，以及认为朋友会对制定糖尿病治疗计划做出负面反应的看法。 糖尿病自我护理因为关于友谊对糖尿病结果的积极方面的文献是混合的， 我们研究潜在的积极和消极关系的机制。在某种程度上， 有益的，潜在的机制包括积极的影响，向朋友透露糖尿病， 认为朋友会积极回应自我照顾。在某种程度上，朋友的融合是有害的， 潜在的机制包括易受朋友影响和分心。因为同伴关系 在家庭关系的背景下发生，我们也将研究这两种关系之间的协同作用。 我们将招募160名患有糖尿病的青少年，从9年级到11年级， 为期4天的EMA研究，其中还评估了与朋友和家人的互动 如前面提到的机制。EMA是一种创新的方法，允许人们利用正在进行的经验， 它们自然地展开，并检查朋友关系与结果之间的联系中的个人差异。的 手术将在6个月后的年底重复进行。变量的调查措施将作为第二次评估 解决同样问题的方法。回归、多级建模、中介、适度和 将使用介导的缓和。这项研究在关注朋友、使用多个 方法，创建一个创新的衡量朋友的知识，并采用了强烈的关注机制。 1

Abstract Type 1 diabetes is one of the most common chronic diseases among children. Managing type 1 diabetes is a complicated, labor intensive effort as one has to monitor blood glucose levels throughout the day, monitor diet, exercise, inject insulin, and adjust insulin based on these activities. The failure to engage in appropriate self- care behavior is problematic as uncontrolled blood sugars can pose both short-term and long-term threats to health. Adolescence is characterized as a developmental period in which youth with type 1 diabetes face difficulties in maintaining good glycemic control, in part due to declines in self-care behavior. Much of the research aimed at this decline has focused on the family, but peer relationships are another important and neglected aspect of youth's social environment. Thus, the present proposal focuses on the role that friends play in the psychological, behavioral, and physical health of adolescents with type 1 diabetes. We have three specific aims: (1) to examine the relations of friend integration and friend conflict to psychological well-being and diabetes outcomes (self-care behavior, glycemic control); (2) to identify potential mechanisms that explain the link of friend integration and friend conflict to these outcomes; (3) to examine the trait of unmitigated communion (i.e., overinvolvement in others to the neglect of the self) as a moderator of the relations of friend integration and friend conflict to outcomes, predicting that links will be stronger for those high in unmitigated communion. We hypothesize that friend conflict will lead to increased psychological distress, distraction from self-care, failure to discuss diabetes, and the perception that friends will respond negatively to the enactment of diabetes self-care. Because the literature on the positive aspects of friendship to diabetes outcomes is mixed, we examine mechanisms for potential positive and negative relations. To the extent that friend integration is beneficial, potential mechanisms include positive affect, disclosure to friends about diabetes, and the perception that friends will respond positively to self-care. To the extent that friend integration is detrimental, potential mechanisms include vulnerability to friend influence and distraction. Because peer relationships occur in the context of family relationships, we also will examine the synergy between the two relationships. We will enroll 160 teens with diabetes in 9th through 11th grades and conduct an ecological momentary assessment (EMA) study over a 4-day period in which interactions with friends and family are assessed as well as previously noted mechanisms. EMA is an innovative method that allows one to tap ongoing experiences as they naturally unfold and to examine within-person variability in links of friend relations to outcomes. The procedure will be repeated 6 months later at yearend. Survey measures of variables will be assessed as a 2nd approach to address the same questions. Regression, multi-level modeling, mediation, moderation, and mediated moderation will be used. The research is highly significant in focusing on friends, using multiple methods, creating an innovative measure of friend knowledge, and employing a strong focus on mechanisms. 1