Positive psychological resources, self-management behavior, and glycemic outcomes in adolescents with type 1 diabetes and elevated diabetes distress.

OBJECTIVE: Positive psychological constructs (e.g., benefit finding, resilience, and diabetes strengths) have been associated with greater engagement in self-management behaviors among teens with type 1 diabetes (T1D). However, for teens with T1D experiencing diabetes distress, these potentially protective associations are less understood. To explore the potential protective functions of positive psychological constructs, we investigated their associations with subjective and objective diabetes self-management behaviors and health outcomes among adolescents with diabetes distress. METHODS: This secondary analysis used baseline data from a two-site intervention trial among adolescents with T1D and elevated diabetes distress. Participants (n = 172, ages 12-18, M(SD) = 15.7(1.6) years; 56% female) completed validated measures of benefit finding, resilience, diabetes strengths, self-management behaviors, and health-related quality of life (HRQOL). Objective self-management was measured via continuous glucose monitor percent time active. Glycated hemoglobin A1c (HbA1c) (glycemic outcome) was collected via electronic health records or dried blood spots. Separate hierarchical linear regressions for each outcome were conducted controlling for demographic and medical covariates and diabetes distress. RESULTS: Positive psychological constructs explained additional variance in self-management beyond distress and demographic and medical covariates (ps < .05). Diabetes strengths consistently predicted self-management and HRQOL (ps < .05), whereas benefit finding and resilience showed limited associations; none of the positive constructs were associated with HbA1c. CONCLUSIONS: Given robust links with self-management and HRQOL, above and beyond diabetes distress, diabetes strengths and other positive psychological constructs may serve as resilience resources in adolescents with T1D. These findings suggest interventions targeting diabetes strengths may be promising to enhance engagement and HRQOL in this high-risk population.