Lewin AB, Heidgerken AD, Geffken GR, et al. The relation between family factors and metabolic control: The role of diabetes adherence

Department of Clinical and Health Psychology, Box 100165, University of Florida, Gainesville, Florida 32610-0165, USA.
Journal of Pediatric Psychology (Impact Factor: 2.91). 04/2006; 31(2):174-83. DOI: 10.1093/jpepsy/jsj004
Source: PubMed

ABSTRACT To examine family factors as predictors of metabolic control in children with type 1 diabetes and determine whether adherence behaviors mediate this relationship.
Participants were 109 children (ages 8-18) and a parent. Measures of diabetes-specific family functioning and an adherence interview were completed. Glycosylated hemoglobin (HbA1c) was the index of metabolic control.
Family functioning and adherence were strongly associated with metabolic control. Combined with demographic information, these constructs accounted for 49% of the variance in metabolic control. Age moderated the relation between aspects of family functioning and HbA1c. Path analyses suggest that adherence mediates the relationship between family functioning and metabolic control.
Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.

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Available from: Adam B. Lewin, Jul 11, 2014
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    • "For example, research has shown that psychological problems such as depression and disturbed eating behavior are elevated in children with T1D and associated with adherence problems and suboptimal glycemic control (Colton, Olmsted, Daneman, Rydall, & Rodin , 2004; Colton, Olmsted, Daneman, & Rodin, 2013; Reynolds & Helgeson, 2011). In addition, family conflict has consistently been associated with lower levels of adherence and worse glycemic control in youth with T1D (Butler et al., 2008; Drotar et al., 2013; Lewin et al., 2006). Insulin omission (Burdick et al., 2004; Weissberg-Benchell et al., 1995), failure to bolus correctly (Danne et al., 2008; Mehta, Quinn, Volkening, & Laffel, 2009) and decreased self-monitoring of blood glucose (Levine et al., 2001; Weissberg-Benchell et al., 1995) are common in adolescent patients, and often associated with psychosocial problems. "
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    ABSTRACT: The significant role of psychosocial factors in the management of type 1 diabetes in youth has been well documented. The International Society for Pediatric and Adolescent Diabetes (ISPAD) therefore published the Clinical Practice Consensus Guidelines for psychological care of young patients. However, it is unclear if and how these guidelines are being implemented. A questionnaire was created to assess implementation of the guidelines and directed to physicians through the ISPAD listserve via a web-based survey. One hundred fifty-five participants from 47 countries completed the survey. Ninety-six percent of respondents reported that they work in a team with other professionals, and 95 % of teams discuss psychological difficulties associated with diabetes management. Seventy-two percent of respondents reported having "easy access" to a mental health specialist (MHS). In 56 % of practice settings, the MHS is considered to be part of the team; 43 % participate in routine clinic visits and 26 % see all patients. Seventy percent screen for psychological problems and 57 % assess family functioning. Psychosocial or behavioral interventions addressing psychosocial and regimen adherence difficulties are offered by 79 % of teams. Psychological care is available for many children with diabetes worldwide. Yet, nearly 30 % of teams do not have access to a MHS. More training in the recognition of psychosocial problems and counseling skills is warranted. More advocacy is needed to increase availability and utilization of psychological services in routine diabetes care.
    Journal of Clinical Psychology in Medical Settings 05/2014; 21. DOI:10.1007/s10880-014-9395-2 · 1.49 Impact Factor
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    • "The DFBC assesses family behaviors that may support or interfere with the appropriate adherence to a youth's diabetes treatment regimen. Research on this measure has indicated that the seven-item negative/unsupportive scale is most strongly associated with T1D adherence and glycemic control (Lewin et al., 2006; Shafer et al., 1986), and is validated for use with youth aged 7 to 18 years (Lewin et al., 2005). Therefore, this study only used the seven negative/unsupportive items for analyses, where higher scores on the negative unsupportive/factor relate to more negative/unsupportive behavior. "
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    ABSTRACT: This study examined relations among diabetes-specific family factors, adherence to medical regimen, quality of life (QOL), and glycemic control in youth and adolescents with type 1 diabetes. During an endocrinologist visit, patient and parent–caregiver dyads (n = 70) completed family factors and QOL measures and participated in a structured interview to assess medical regimen compliance, and the patient's glycemic control was assessed by a medical professional. Combined measures accounted for 42% of the variance in glycemic control. QOL partially mediated adherence and glycemic control. Ethnic minority status was associated with poorer glycemic control.
    Children s Health Care 10/2013; 42(4):295-310. DOI:10.1080/02739615.2013.842455 · 0.95 Impact Factor
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    • "A large body of research has investigated links between family variables and outcomes such as treatment adherence and metabolic control. Most studies show that parental emotional support, particularly with regards to the difficulties of living with diabetes, is associated with improved metabolic control, whereas unsupportive parental behavior is correlated with regimen adherence problems and poor metabolic control (Burroughs, Harris, Ponious, & Santiago, 1997; Kyngäs & Rissanen, 2001; Lewin et al., 2006; Levandowski & Drotar, 2007). These studies are representative of research on families of children with diabetes in that they are parent-driven. "
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    ABSTRACT: Background For children with diabetes, metabolic control typically declines across the adolescent years. OBJECTIVE: The longitudinal interplay between supportive relationships with parents and metabolic control were investigated in families that differ in parents' restrictiveness. METHOD: The time-dependent links between perceived parental social support and metabolic control were investigated in a sample of 109 German adolescents with diabetes. 3 waves of data were collected at annual intervals; metabolic control (indexed by HbA1c) was assayed by physicians annually. RESULTS: Family restrictiveness moderated longitudinal associations between metabolic control and perceived social support. For adolescents reporting high family restrictiveness, poorer initial metabolic control predicted greater subsequent declines in perceived parent social support, and lower initial perceived parental social support predicted greater subsequent deterioration in metabolic control. CONCLUSION: The findings add to the growing body of work suggesting that restrictiveness is a risk factor that exacerbates problems associated with low perceived parental support.
    Journal of Pediatric Psychology 04/2013; 38. DOI:10.1093/jpepsy/jst006 · 2.91 Impact Factor
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