Family conflict in type 1 diabetes: Who is at risk?

Abstract

Background/Objective: Diabetes-related conflict between caregiver and child has been associated with lower quality of life, reduced treatment adherence, and higher hemoglobin A1C. The objective of this project was to identify patient and family characteristics associated with higher levels of diabetes-specific family conflict. Methods: This was a cross-sectional study. Caregivers of children aged 4-to 18-years-old with type 1 diabetes were recruited from diabetes clinics across British Columbia. Data were collected through chart reviews and patient surveys, including the Diabetes Family Conflict Scale and the Adherence in Diabetes Questionnaire. All caregivers and children ≥8-years-old were invited to complete the survey. Potential predictors were explored using univariate and multivariable linear regression models. Results: In the unadjusted analysis, higher caregiver report of conflict (n = 196) was associated with: low family income, non-Caucasian ethnicity, missed school, older age at diagnosis, and insulin regimen (2-3 injections/day rather than multiple daily injections or pump). When all variables were adjusted for simultaneously, income, insulin regimen, one or more stay at home parent and recent hospitalization were significant. For the child report (n = 111), higher maternal education was associated with lower conflict in the unadjusted analysis and non-Caucasian ethnicity was associated with higher conflict in the adjusted analysis. Conclusions: This exploratory study identified possible novel associations between patient and family characteristics and diabetes-related family conflict.

Fear of hypoglycemia and quality of life in young people with type 1 diabetes and their parents in the era of sensor glucose monitoring

“…Pre-existing suboptimal glycemic control in youth is often a result of multiple influencing factors, one of these factors can be suboptimal treatment adherence ( 7 ). This can lead to family conflicts that can deteriorate suboptimal glycemic control ( 8 ). Among others, fear of hypoglycemia even without documented low glucose levels seems to be a major determinant in increasing the psychological burden for children with T1D ( 9 ).…”

Longitudinal associations between family conflict, parent engagement, and metabolic control in children with recent-onset type 1 diabetes

“…In the future, studies should attempt to solicit perceptions from fathers or other caregivers. 7 27 Another focus of future research should be to confirm our study findings using objective measures of parent engagement in child T1D care, such as the days of continuous glucose monitor use and children’s insulin Bolus score. 25 Similarly, future studies should include the methodology to assess for biomarkers (eg, C peptide) that may signal residual beta cell function to personalize how long young school-age children with T1D are experiencing the honeymoon effect and how exiting this period specifically relates to parents’ perceptions of diabetes-specific family conflict, parent engagement in child T1D care, and children’s HbA1c levels.…”

“… 8 15 In this way, diabetes-specific family conflict, which is increasingly recognized as a potentially modifiable factor in diabetes management, could also be an important clinical target for intervention. 7 8 10 15 For families of younger children with T1D and families of children with recent-onset T1D, we know far less about how diabetes-specific family conflict may relate to suboptimal T1D engagement or child HbA1c and this could represent a critical gap in knowledge related to the clinical management of these families.…”

“…For families of youth with T1D who are beyond 24 months postdiagnosis, studies suggest that diabetes-specific family conflict may be an important parent/child factor to include when examining child glycemic levels. [7][8][9][10][11][12][13] Diabetes-specific family conflict is a construct that reflects how much a parent and child with T1D argue about T1D management. 14 Related, it may be important to include a measure of either youth or parent engagement with T1D care to assess how often parents or youth are participating in T1D management.…”

Inclusion of Children with Diabetes Mellitus in Czech Schools

“…139-148). A study by Fox et al (2020) identifi ed possible new links between the characteristics of the patient and family and family confl ict relating to diabetes. Confl ict between the carer (their education) and child relating to diabetes was linked to a poorer quality of life, reduced adherence to treatment, and higher haemoglobin A1C.…”