Date of Award

Spring 2021

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Kaugars, Astrida

Second Advisor

Gordon, Nakia

Third Advisor

Magnus, Brooke


Type 1 diabetes (T1D) is an increasingly common chronic illness in children and adolescents that can result in short- and long-term health complications. Adolescents with T1D represent a uniquely vulnerable population, as both physical and psychological disease outcomes tend to deteriorate during this period of development. Thus, among adolescents it is crucial to gain further understanding of what psychological and contextual factors promote optimal disease management. While traditional methods of assessment in this population involve one-time, long-term measurements of psychosocial factors and glycemic control, ecological momentary assessment (EMA), including daily diaries, are increasingly used to capture change processes both between and within individuals. The present study utilized EMA methods (daily diaries for seven days) to explore associations between general stress (GS), diabetes-specific stress (DSS), and glycemic control. Anxiety was measured at baseline and examined as a moderator. Forty-four adolescents (ages 13-17) diagnosed with T1D were recruited from diabetes summer camps. Participants completed the Revised Children’s Manifest Anxiety Scale, 2nd Edition at camp. Daily diaries, including measures of GS and DSS, were completed in the fall. Participants uploaded blood glucose values via Tidepool®, which were used to calculate daily mean blood glucose values. Daily GS and DSS scores were used to quantify both within- and between-subjects variance in each construct. Multilevel model analyses revealed that increased within-subjects fluctuations in daily DSS were predictive of poorer daily glycemic control. Conversely, betweensubjects variation in average levels of DSS across the measurement period did not play a significant role in predicting mean daily blood glucose. GS levels were not predictive of glycemic control at either level. Additionally, trait anxiety did not moderate the association of fluctuations in daily DSS with glycemic control. Overall, the association between fluctuations in daily diabetes-specific stress and same-day glycemic control highlights the need for clinicians to focus on bolstering adolescents’ adaptive responses to daily disease-related stressors. Additionally, this study underscores the importance of examining both between- and within-person psychosocial processes in individuals with T1D in order to fully understand the mechanisms underlying disease management.

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