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病之一。管理1型糖尿病是一项 复杂的劳动密集型工作，因为人们必须全天监测血糖水平，监测饮食， 锻炼，注射胰岛素，并根据这些活动调整胰岛素。未能进行适当的自我管理 护理行为是有问题的，因为不受控制的血糖可能会对 健康。青春期是指患有1型糖尿病的青少年面临的一个发育期 难以维持良好的血糖控制，部分原因是自我护理行为的下降。世界上大部分的 针对这种下降的研究一直集中在家庭上，但同伴关系是另一个重要的 年轻人社会环境中被忽视的方面。因此，本提案侧重于朋友所发挥的作用 对患有1型糖尿病的青少年的心理、行为和身体健康的影响。我们有三个具体的 研究目的：(1)考察朋友融合、朋友冲突与心理幸福感的关系； 糖尿病结果(自我护理行为、血糖控制)；(2)确定解释 朋友整合和朋友冲突与这些结果之间的联系；(3)考察了未缓解的特质 交融(即过度参与他人而忽略自我)，作为朋友关系的调解人 融合和朋友与结果的冲突，预测那些在未缓解的情况下更高的联系将会更强 圣餐。我们假设朋友之间的冲突会导致更多的心理困扰，分散注意力 自我照顾，没有讨论糖尿病，以及认为朋友们会对颁布 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参差不齐， 我们考察了潜在的积极和消极关系的机制。在一定程度上，朋友整合是 有益的、潜在的机制包括积极的影响，向朋友披露糖尿病，以及 认为朋友会对自我照顾做出积极的反应。在一定程度上，朋友之间的融合是有害的， 潜在的机制包括易受朋友影响和分心。因为同伴关系 发生在家庭关系的背景下，我们还将考察这两种关系之间的协同作用。 我们将招收160名9至11年级的糖尿病青少年，并进行生态瞬间 为期4天的评估(EMA)研究，其中也评估了与朋友和家人的互动 正如前面提到的机制。EMA是一种创新的方法，允许人们利用正在进行的体验 它们自然而然地展开，并考察朋友关系与结果之间的联系的人内可变性。这个 该程序将在6个月后的年底重复。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、多层建模、调解、缓和和 将使用调解的缓和措施。这项研究对于关注朋友，使用多个 方法，创建朋友知识的创新衡量标准，并将重点放在机制上。 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