Psychosocial Factors and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes

IMPORTANCE Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions. OBJECTIVE To identify psychosocial factors associated with glycated hemoglobin (HbA(1c)) levels in young adults with youth-onset type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS For the iCount cohort study, HbA(1c) levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023. MAIN OUTCOMES AND MEASURES Glycemic control was examined categorically (high [>= 8.0%] vs low [<8.0%] HbA(1c)), continuously (HbA(1c) level), and over time (change in HbA(1c): decreased >= 0.5%, remained stable, or increased >= 0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA(1c) of 8.0% or greater, T2 HbA(1c) level, and change in HbA(1c). RESULTS Of the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA(1c) data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA(1c) of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA(1c) at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA(1c) at T2. Diabetes distress was associated with higher HbA(1c) level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA(1c) decrease of at least 0.5% over 1 year. CONCLUSIONS AND RELEVANCE In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA(1c) over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.