{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:57:33Z","timestamp":1791809853592,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,10]],"date-time":"2019-07-10T00:00:00Z","timestamp":1562716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100006544","name":"Ministry of Health, State of Israel","doi-asserted-by":"publisher","award":["3-12108 2808"],"award-info":[{"award-number":["3-12108 2808"]}],"id":[{"id":"10.13039\/501100006544","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the impact of patients\u2019 understanding of biochemical processes involved in glucose regulation (causal\u2010biochemical knowledge) and of diabetes self\u2010management knowledge on adherence to treatment recommendations among adolescents with type 1 diabetes mellitus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adolescents with type 1 diabetes mellitus, aged 12\u201318\u00a0years and able to read and write in Hebrew or in Arabic were eligible. Participants were recruited between August 2016 \u2013 January 2018 during routine visits to the Paediatric Diabetes Clinic; informed consent was obtained as customary. Patients completed sociodemographic, clinical and type 1 diabetes mellitus self\u2010management and biochemical knowledge questionnaires. Adherence to treatment was assessed by patients\u2019 serum HbA1c levels, collected from medical records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010seven patients participated in the study. Mean HbA1c levels were 9.2% (1.9%) and only 24 (24.7%) patients met the recommended HbA1c\u00a0\u2264\u00a07.5%. Lower HbA1c levels were strongly associated with higher family income, older age at diagnosis and with better type 1 diabetes mellitus self\u2010management and causal\u2010biochemical knowledge. A regression model showed that causal\u2010biochemical knowledge contributed to the variance in HbA1c levels. Furthermore, causal\u2010biochemical knowledge, but not self\u2010management knowledge, was found to mediate the negative relationship between low family income and high HbA1c levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Causal\u2010biochemical knowledge is a valuable component for the adherence to diabetes care and glycaemic control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Impact<\/jats:title><jats:p>Our study suggests that causal knowledge is a valuable component that should be included in nursing and healthcare educational programmes for adolescents with type 1 diabetes mellitus.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jan.14098","type":"journal-article","created":{"date-parts":[[2019,6,14]],"date-time":"2019-06-14T08:54:02Z","timestamp":1560502442000},"page":"2701-2709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Adherence to diabetes care: Knowledge of biochemical 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