Parental Diabetes Behaviors and Distress Are Related to Glycemic Control in Youth with Type 1 Diabetes: Longitudinal Data from the DINO Study

Abstract

Objective To evaluate (1) the longitudinal relationship between parental well-being and glycemic control in youth with type 1 diabetes and (2) if youth's problem behavior, diabetes parenting behavior, and parental diabetes-distress influence this relationship. Research Design and Methods Parents of youth 8–15 yrs (at baseline) (N = 174) participating in the DINO study completed questionnaires at three time waves (1 yr interval). Using generalized estimating equations, the relationship between parental well-being (WHO-5) and youth's HbA1c was examined. Second, relationships between WHO-5, Strength and Difficulties Questionnaire (SDQ), Diabetes Family Behavior Checklist (DFBC), Problem Areas In Diabetes-Parent Revised (PAID-Pr) scores, and HbA1c were analyzed. Results Low well-being was reported by 32% of parents. No relationship was found between parents' WHO-5 scores and youth's HbA1c (β = −0.052, p = 0.650). WHO-5 related to SDQ (β = −0.219, p < 0.01), DFBC unsupportive scale (β = −0.174, p < 0.01), and PAID-Pr (β = −0.666, p < 0.01). Both DFBC scales (supportive β = −0.259, p = 0.01; unsupportive β = 0.383, p = 0.017), PAID-Pr (β = 0.276, p < 0.01), and SDQ (β = 0.424, p < 0.01) related to HbA1c. Conclusions Over time, reduced parental well-being relates to increased problem behavior in youth, unsupportive parenting, and parental distress, which negatively associate with HbA1c. More unsupportive diabetes parenting and distress relate to youth's problem behavior.

Assessing the clinical utility of the diabetes eating problem survey‐revised (DEPS‐R) in adolescents with type 1 diabetes

“…Others have found that family cohesion is associated with healthy weight control practices within the T1D population . Eilander et al found that parental distress around diabetes care was associated with higher HbA1c levels. The questions selected to assess for conflict in our study were a small subset of questions taken from the Family and Diabetes Conflict Scale and therefore have not been validated and should be interpreted with caution.…”

“…DEPS scores of 8 [4-11.7], 16 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] and 28 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36], respectively, as shown in Figure 2.…”

“…Although there have been studies that have attempted to delineate clinical characteristics that place individuals with T1D at risk for developing DE behaviours, findings have been inconsistent in relation to psychosocial and familial factors . In addition, studies have used different methods to detect disordered eating behaviours, which are often labour intensive and do not translate into clinical practice.…”

“…Although there have been studies that have attempted to delineate clinical characteristics that place individuals with T1D at risk for developing DE behaviours, findings have been inconsistent in relation to psychosocial and familial factors. [10][11][12] In addition, studies have used different methods to detect disordered eating behaviours, which are often labour intensive and do not translate into clinical practice. For example, the Eating Disorder Examination is a diagnostic instrument which consists of a semi-structured clinical interview and is considered to be the gold standard for diagnosing an eating disorder.…”

Family and household structure are associated with acute type 1 diabetes complications: results of cross‐sectional analyses

“…Regarding parenting style, parents' use of authoritarian-like strategies was associated with poorer glycaemic control after 3 months (b = 0.189, P ≤ 0.05) and after 6 months (b = 0.254, P ≤ 0.05) of observation of children with new-onset diabetes (diabetes duration of <1 year at baseline) [7]. Eilander et al also reported an association between unsupportive diabetes-specific parenting behaviour (b = 0.383, P = 0.02) and parental diabetes distress (b = 0.276, P = 0.001), with poorer glycaemic control in children/ adolescents aged 8-15 years at baseline [8]. In addition, adolescents' perception of parental over-involvement in diabetes care (assessed by the parental involvement scale from the Diabetes Quality of Life for Youth -Short Form, score 0-12 [9]) was related to poorer metabolic control (b = 0.099, P < 0.001) and more episodes of diabetic ketoacidosis (b = 0.05, P < 0.001).…”