T1D Risk-Taking Survey Reliable, Valid for Use Among Adolescents

Despite advances in diabetes treatment that have led to better disease management in most patients, adolescents and young adults with type 1 diabetes (T1D) have not seen improvement in glycemic levels or mortality. Considering this demographic is known for increased risk-taking behavior, a recent study published in Pediatric Diabetes assessed the Diabetes-Specific Risk-Taking Inventory (DSRI), a survey that aims to obtain reliable information about risk taking in adolescent and young adult patients with diabetes.

Adolescent risk-taking behaviors are associated with increased morbidity and mortality in this population, the authors noted, and those who have T1D take the same amount of risk as their peers when it comes to non–T1D-related activities. “Thus, risk-taking behavior increases around the same time that engagement in diabetes self-management generally decreases and A1C [glycated hemoglobin] increases, potentially placing adolescents at elevated risk for deleterious outcomes related to their diabetes,” the authors wrote.

In a previous publication, the authors of the current study developed the DSRI to determine the effect of risk taking on T1D self-management in adolescents. The current study aims to examine the psychometric properties of the DSRI, which instructs respondents to report the frequency with which they have engaged in 31 T1D-specific risk-taking behaviors in the past year.

Prior to the DSRI, no current diabetes-specific measures of adherence, general risk taking, diabetes knowledge, or psychosocial functioning captured diabetes-specific risk-taking behaviors in adolescents with T1D. It is a self-reported questionnaire developed by a multidisciplinary team, and its format can help overcome the challenges associated with having in-clinic conversations, including adolescents’ hesitancy to share sensitive information about lifestyle habits.

A total of 224 patients from the national T1D Exchange Registry were surveyed, all of whom were aged 15 to 18 years. Older teens, in particular, have more risk-taking opportunities than younger teens, which is why this age group was chosen. Eligible patients had T1D for more than 1 year, had an available A1C measurement in the database in the past year, and had a most recent A1C measurement between 6% and 13%. Of the 224 participants who responded to the first survey, 165 also completed a follow-up survey 1 month later.

In addition to the DSRI, participants completed the Self-Care Inventory-Revised (SCI-R) to assess diabetes self-management behaviors, the risk-taking subscale of the Risk-Taking and Self-Harm Inventory for Adolescents (RTI-A) to assess general risk-taking, and the Behavior Rating Inventory of Executive Functions, 2nd Edition, Short-Form Self-Report (BRIEF-2 SF-SR) to gauge general executive functioning. Incidence of severe hypoglycemia and diabetic ketoacidosis over the past year were also self-reported, and A1C values were collected from electronic medical records.

Overall, the DSRI showed internal consistency and reliability, as well as test-retest reliability. Significant associations between the DSRI and T1D engagement measures, the SCI-R, RTI-A, BRIEF-2 SF-SR, and medical records data showed validity. DSRI responses also accounted for the majority of variations in patients’ most recent A1C measure, suggesting incremental validity. Adolescents who reported a severe hypoglycemic event in the previous year also had higher DSRI scores than patients who did not.

“Overall, initial psychometrics suggest the DSRI is a reliable and valid measure of risks that adolescents may take with their T1D care,” the authors concluded. “This innovative self-report measure has potential to be an actionable clinical tool to screen for high-risk behaviors not routinely assessed in T1D clinical care.”

Important next steps include research and development of interventions that may prevent or reduce risk-taking behavior in adolescents with T1D and other chronic illnesses.

Reference

Wasserman RM, Patton SR, Clements MA, Guffey D, Schwartz DD, Anderson BJ. Risky self-management behaviors in adolescents with type 1 diabetes: measurement validation for the Diabetes-Specific Risk-Taking Inventory (DSRI). Pediatr Diabetes. Published online June 25, 2022. doi:10.1111/pedi.13387