Family Density and SES Related to Diabetes Management and Glycemic Control in Adolescents With Type 1 Diabetes

Abstract

Beyond SES, FD plays a significant role in adherence and glycemic control via diabetes-related conflict. In contrast, the effects of single-parent status were indistinguishable from those of SES. FD provides distinct information related to adolescent glycemic control.

ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes

“…21 A collaborative parent-child relationship with shared responsibilities for diabetes management is associated not only with better regimen adherence but also with improved emotional functioning. 69,77,78 Socio-demographic family factors such as singleparent households or higher family density (more youth per adults in the household), [78][79][80][81][82] lower family income, and racial/ethnic minority status 78,[81][82][83][84][85][86][87] are associated with less optimal parental involvement in diabetes management and greater risk for poor control of diabetes.…”

Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers

“…For example, youth in homes with a larger ratio of children to parents have higher diabetes‐related conflict and those with single parents have higher youth behavior problems, family conflict, parenting stress, and less parent involvement in diabetes management . The relationship between single‐parent family structure and emotional burden may be confounded by low socioeconomic status (SES), which is associated with higher parenting stress, diabetes‐related family conflict, and youth depressive symptoms . Diabetes‐related burdens among low SES families are related to greater exposure to stressors and adversity, as well as less access to tangible (eg, insurance coverage) and psychosocial resources (eg, self‐esteem, optimism, and social support) .…”

“…24,25 Some youth and families are more vulnerable to diabetes-related emotional burdens than others. For example, youth in homes with a larger ratio of children to parents have higher diabetes-related conflict 26 and those with single parents have higher youth behavior problems, family conflict, parenting stress, and less parent involvement in diabetes management. 27,28 The relationship between single-parent family structure and emotional burden may be confounded by low socioeconomic status (SES), 28 which is associated with higher parenting stress, diabetes-related family conflict, and youth depressive symptoms.…”

Updates in behavioural and psychosocial literature in adolescents with type 1 diabetes

“…Caccavale et al [23] studied whether family density, using a youth:adult ratio, was a better way to assess family risk status when compared with other SES markers. The authors found that lower family density was associated with better glycemic control via less conflict and greater adherence and argued that family density provides additional information beyond routine SES analysis.…”