Electronic Theses and Dissertations



Document Type


Degree Name

Doctor of Philosophy



Committee Chair

Kristoffer Berlin

Committee Member

Kathryn Howell

Committee Member

Angelica Eddington

Committee Member

Nicholas Simon


Vascular complications result in significant morbidity and mortality in individuals with type 1 diabetes. Certain measures such as the urinary albumin-to-creatinine ratio can assess risk for later diabetes complications by determining the amount of protein leaking from the kidneys (an early sign of kidney damage). Based on a conceptual framework, this study used growth curve and latent variable mixture modeling to evaluate individual and family characteristics, psychosocial responses, individual and family responses, and metabolic variables (hemoglobin A1c and DKA hospitalizations) that predict urinary albumin-to-creatinine ratio (ACR) trajectories over the span of three years. Adolescents (N = 142) 12-18 years old with type 1 diabetes (Mage = 15.73, SD = 1.66; MHbA1c = 10.56, SD = 2.48) and their caregivers completed measures assessing demographics, psychosocial functioning, diabetes stress, diabetes-related family conflict, family functioning, and engagement in behaviors consistent with recommended treatment. Medical records were retrospectively reviewed to obtain ACR, HbA1c, DKA hospitalizations and other medical variables. Variable centered analyses showed that longer illness duration predicted higher ACR at baseline. Additionally, greater engagement in behaviors consistent with recommended treatment based on youth report predicted lower ACR at baseline and greater family functioning predicted lower ACR change over time. Latent profile analysis found a three class model fit best (Class 1 = intermediate level of ACR (n = 35, 51%), Class 2= elevated ACR (n = 49, 34%), Class 3 = low ACR (n = 61, 42%)). Greater Tanner stage was associated with inclusion in classes characterized by lower ACR. Thus, Tanner stage and ACR should be monitored in youth to identify individuals at risk for later complications. Additionally, family based interventions may be critical for preventing later diabetes complications in youth.


Data is provided by the student

Library Comment

Dissertation or thesis originally submitted to ProQuest.


Open Access