Adherence and Glycemic Control in Adolescents with Type 1 Diabetes: The Moderating Role of Age, Gender, and Family Support

Abstract

Adherence and glycemic control usually decrease during adolescence and family relationships influence diabetes outcomes. This study analyzed the interaction effect of adolescents' family support, age, and gender in the relationship between adherence and glycemic control in adolescents with Type 1 Diabetes. The sample included 100 adolescents with Type 1 Diabetes and one of their parents during a routine endocrinology appointment. Adolescents answered the Self-Care Inventory-Revised, the Diabetes Family Behavior Scale and were also assessed on the glycosylated hemoglobin. The three-way interaction between adherence, family support, and adolescents' age/gender was both negatively significant and explained 24.12% and 22.02% of the variance, respectively. Higher family support, being female, and younger age moderated the relationship between adherence and glycemic control. According to results, it is important that intervention programs provide negotiation skills, according to adolescent's age and gender in the process of transferring diabetes management responsibility in order to promote better adherence to diabetes self-care, glycemic control, and prevent family conflicts regarding diabetes management.

Association of family structure with type 1 diabetes management and outcomes in adolescents: A population‐based cross‐sectional survey

“…According to Baumer et al preplanned outpatient appointments were less likely to have been attended if a child did not live with both parents (78.8% vs. 83.7%, p < 0.001), indicating temporal constraints of single parents 35 . Other explanatory approaches may include difficulties in providing, supervising and monitoring diabetes management (i.e., regarding the SMBG frequency, meals and snacks) 20,36 ; a diabetes caregiver other than the mother 37 ; health literacy 38 ; prevalence of life stressors 36 ; and family dynamics, such as cohesion, support, and conflict 20,39 …”

Adherence in pediatric renal recipients and its effect on graft outcome, a single‐center, retrospective study

“…Non-adherence in adolescents is said to be significantly higher than in younger children due to neurological changes as well as emotional and social challenges. [9][10][11] It is suggested that the late maturation of the prefrontal cortex conflicts with the requested action planning and risk control needed to act responsibly. 12 Non-adherence is likely to correlate both with the occurrence of rejections and the formation of dnDSA.…”

“…While every stage of development has its own tasks and characteristics, adolescence is particularly challenging. Non‐adherence in adolescents is said to be significantly higher than in younger children due to neurological changes as well as emotional and social challenges 9‐11 …”

Effects of mobile health interventions on improving glycemic stability and quality of life in patients with type 1 diabetes: A meta‐analysis

“…The difference in engagement in treatment between males and females might influence glycemic stability. In addition, various factors may affect engagement in diabetes care, such as social support and depression (Almeida et al, 2019; Krass et al, 2015; Shrestha et al, 2013). Although the included studies did not clearly describe whether those factors were collected at recruitment, these issues could not have been identified in the meta‐analysis.…”

“…Women tend to be more sensitive to symptoms of illness and more frequently seek care than men (Regitz-Zagrosek, 2012). Previous studies found that male populations with T1D had passive attitudes and low adherence to treatments for glycemic control (Almeida et al, 2019;Fitzgerald et al, 1995). The difference in engagement in treatment between males and females might influence glycemic stability.…”