Blood Glucose Monitoring and Glycemic Control in Adolescence: Contribution of Diabetes-Specific Responsibility and Family Conflict

Abstract

Purpose To examine age and time trends in responsibility for diabetes management tasks and diabetes-specific family conflict and their relationship to blood glucose monitoring (BGM) frequency and blood glucose control (HbA1c). Methods A sample of 147 adolescents (mean=15.5±.4 years) with type 1 diabetes and their caregivers completed measures of diabetes-specific responsibility and family conflict at baseline and six months. BGM frequency and HbA1c were measured during outpatient clinic appointments. Results Responsibility for diabetes management tasks shifted from caregivers to adolescents with increasing age by adolescent and caregiver report. Diabetes-specific conflict was stable. Similar trends in responsibility and conflict were seen over the 6 month follow-up period. Less frequent BGM and higher HbA1c were also observed with increasing adolescent age. Multivariate analyses demonstrated adolescents taking greater responsibility for management tasks and experiencing greater family conflict at baseline reported lower BGM at six months. Family, demographic, psychosocial, and disease-specific variables accounted for 26% of the variance in BGM frequency by both adolescent and caregiver report. Adolescents reporting greater diabetes-specific family conflict at baseline experienced higher HbA1c values at six months. Variables accounted for 23 and 28% of the variance in HBA1c by adolescent and caregiver report respectively. Conclusions Diabetes-specific responsibility and conflict have important implications for improving disease outcomes. Interventions targeting responsibility and conflict (i.e., reducing conflict while keeping caregivers involved in diabetes management) may help prevent the deterioration in BGM and HbA1c frequently seen during adolescence.

Diabetes control and the influence of family functioning

“…Problematic family functioning is associated with unbalanced levels of cohesion (a score < 15 being designated disengaged and > 85 being enmeshed) and flexibility (a score of <15 being rigid and > 85 being chaotic). Reliability of the FACES IV scales has been doi: 10.7243/2050-0866- [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] found to be acceptable for research and clinical purposes with Cronbach's α values for the scales and subscales being; Cohesion = 0.89, Flexibility = 0.84, Rigid = 0.82, Enmeshed = 0.77, Disengaged = 0.87, and chaotic = 0.86 [16] It has also been shown to discriminate between healthy and problematic family functioning [17].…”

“…This can help parents/carers to consider that "the problem is the problem" rather than "the child is the problem" [32]. It has been suggested that such family approaches may 6 doi: 10.7243/2050-0866- [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] be most effective during early to mid-adolescence, helping the child to effectively progress through this developmental stage, with a more individual approach being adopted in late adolescence [13], but this may be to deprive older adolescents of the opportunity to address wider family concerns. However intervention strategies must work within the existing family system, respecting the parental involvement in the diabetes management tasks, and sometimes shifting the question from "how much involvement?"…”

“…Adolescence is particularly problematic for families because the developmental demands of this phase can make the maintenance of optimal control difficult [4]. Indeed, research indicates that the majority of adolescents with type 1 diabetes tend not to achieve optimal levels of HbA1c [4], and in a recent audit in the UK only 14.5% of children and young people with a HbA1c measurement achieved the recommended target for optimal control [2].…”

“…Indeed, research indicates that the majority of adolescents with type 1 diabetes tend not to achieve optimal levels of HbA1c [4], and in a recent audit in the UK only 14.5% of children and young people with a HbA1c measurement achieved the recommended target for optimal control [2]. When the diabetes arises in childhood the worry for families is increased further by the recognition that the duration of the illness tends to predict the degree of adherence and quality of glycaemic control, because the more prolonged the disease the lower the level of these elements [5].…”

Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test (Preprint)

“…[5,21] Research supports ongoing intervention designed to reduce family conflict in order to improve diabetes-related outcomes. [5,8,[22][23][24] However, resources to address family conflict, including access to social work services, family counseling, and psychological services are sparse in clinical diabetes care. The desires of patients to have these services and the evidence that they are related to superior diabetes outcomes should encourage the field to push for routinely integrating them in the diabetes clinic setting.…”