The impact of cognitive distortions, stress, and adherence on metabolic control in youths with type 1 diabetes

J Adolesc Health. 2004 Jun;34(6):461-7. doi: 10.1016/S1054-139X(03)00215-5.


Purpose: To investigate the role of cognitive distortions in the relationship between adherence behavior, diabetes-specific stress, general stress, and metabolic control.

Methods: Obtained questionnaire data, glucometer readings, and glycosylated hemoglobin (HbgA(1c)) assays from 143 youths (11-18 years old) with type 1 diabetes. Examined path model of relationships between cognitive distortions, stress, adherence behavior, and metabolic control. Data were analyzed using path analysis.

Results: Higher levels of negative cognitive distortions were associated with more stress (both diabetes-specific and general). Higher levels of general stress then led to less adherent behavior and subsequently poorer metabolic control (higher HbgA(1c)). More diabetes-specific stress also led to poorer metabolic control, as well as general stress.

Conclusions: The findings indicate an indirect role of negative cognitive distortions in metabolic control. The current findings suggest that instead of the proposed direct link between cognitive distortions and adherence behavior, an indirect relationship may exist through stress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Glucose / analysis*
  • Child
  • Cognition Disorders / psychology*
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / psychology*
  • Female
  • Glycated Hemoglobin A / analysis*
  • Humans
  • Male
  • Patient Compliance / psychology*
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • United States


  • Blood Glucose
  • Glycated Hemoglobin A