{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:04:52Z","timestamp":1773288292728,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T00:00:00Z","timestamp":1537747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32DK097718"],"award-info":[{"award-number":["T32DK097718"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Nursing Scholarship"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose was to test associations among stressful life events, frequency of missed insulin doses, and glycemic control in young adults with type 1 diabetes (T1D).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The study was a cross\u2010sectional descriptive secondary analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 2,921 participants (ages 18\u201326 years) in the U.S. T1D Exchange Clinic Registry were analyzed. Report of a stressful life event was defined as one or more positive responses on a 17\u2010item stressful life events index and defined as a dichotomous variable (yes or no). Frequency of missed insulin doses was measured using a single self\u2010report item and collapsed into two levels (fewer than three times a week, three or more times a week). The glycosylated hemoglobin (A1c) level recorded at the time of enrollment was used to assess glycemic control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Nearly half (48.6%) of the participants reported having a stressful life event during the previous year. The most frequently reported stressful life events were problems at work or school (16.1%), serious arguments with family members or a close friend (15.2%), and financial problems in the family (13.8%). Compared to the participants not reporting stressful life events, those who reported stressful life events were more likely to be older, female, with a higher educational attainment level, and not working or unemployed. Those who reported a stressful life event were more likely than those who did not to say they typically missed insulin doses at least three times a week and less likely to say they typically missed insulin doses fewer than three times a week (<jats:italic>p<\/jats:italic> &lt; .001 adjusted for age, sex, race or ethnicity, educational attainment level, duration of T1D diagnosis, and insulin delivery method). Mean A1c level was higher for the group who reported having a stressful life event in the past 12 months compared to the group who did not (8.7 \u00b1 1.8% vs. 8.2 \u00b1 1.6%; adjusted <jats:italic>p<\/jats:italic> &lt; .001). The results of a mediation analysis suggest that the measure of frequency of missed insulin doses may be a mediator of the relationship between recent stressful life events and glycemic control (Sobel test: ab = .841, 95% confidence interval = 0.064\u20131.618).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These findings suggest that, for young adults with T1D, the experience of stressful life events may increase their risk for poorer glycemic control, possibly by disrupting adherence with insulin doses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Relevance<\/jats:title><jats:p>Further exploration of these relationships may allow for the potential for identifying those at risk and assisting them with more positive approaches to managing stressful events.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jnu.12428","type":"journal-article","created":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T09:41:16Z","timestamp":1537782076000},"page":"676-686","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8356-2222","authenticated-orcid":false,"given":"Kevin L.","family":"Joiner","sequence":"first","affiliation":[{"name":"<i>Rho<\/i>, Research Fellow University of Michigan School of Nursing  Ann Arbor MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret L.","family":"Holland","sequence":"additional","affiliation":[{"name":"Associate Research Scientist in Nursing Yale University School of Nursing  Orange CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Grey","sequence":"additional","affiliation":[{"name":"<i>Delta Mu<\/i>  Annie Goodrich Professor of Nursing Yale University School of Nursing  Orange CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1037\/0021-843X.109.3.403"},{"issue":"1","key":"e_1_2_8_3_1","first-page":"S1","article-title":"Standards of medical care in diabetes\u20102017","volume":"40","author":"American Diabetes Association","year":"2017","journal-title":"Diabetes Care"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.55.5.469"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2011.01.019"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-1561"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/07448481.2013.805714"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.4.1052"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.3.e221"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12523"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta14110"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309303291401"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/diab.44.8.968"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892-014-0521-1"},{"issue":"12","key":"e_1_2_8_15_1","article-title":"Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus","volume":"2017","author":"Fullerton B.","year":"2014","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/smi.2509"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0897-1897(99)80123-2"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-10-113"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1353\/dem.0.0091"},{"issue":"2","key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1037\/a0018163","article-title":"Relation of stressful life events to metabolic control among adolescents with diabetes: 5\u2010year longitudinal study","volume":"29","author":"Helgeson V. 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