Problems With Self-Regulation, Family Conflict, and Glycemic Control in Adolescents Experiencing Challenges With Managing Type 1 Diabetes

Abstract

These findings suggest that among teens experiencing challenges with managing type 1 diabetes, interventions that decrease family conflict may be critical to promoting optimal glycemic control in those teens with greater problems with self-regulation.

Parent–Child Relationship Quality as a Mediator of the Association between Perceived Stress and Diabetes Self-Management in Adolescents With Type 1 Diabetes

“…In this study, preteens (aged 10-12 years) with T1D reported a better parent-child relationship quality than did teenagers (aged 13-18 years) with T1D. This finding was similar to that found in a U.S. study, which showed that tensions in parent-child relationships peaked among adolescents (aged 13-17 years) (Vaid et al, 2018). As reported previously, adolescents prefer to be independent from their parents, especially when they transition from childhood to adolescence (Fung et al, 2013).…”

Characterization of youth goal setting in the self‐management of type 1 diabetes and associations with HbA1c: The Flexible Lifestyle Empowering Change trial

“…The relative frequency of these themes aligns with the established understanding that adolescents with T1D are moving from dependence to autonomy in their diabetes self‐management during this time period 4,17,32 . We did not observe indication of a positive or negative association between frequency of intention to elicit parent support or frequency of intended joint goals and youth glycemic control in our sample, but it is possible this lack of association is the result of a mixing of effects, and that both goal categories represent a mix of self‐management promoting and challenging parent‐child dynamics (e.g., “adaptive” vs “maladaptive” communication, discrepancies in decision‐making autonomy) that have been shown, respectively, to be favorably and unfavorably associated with youth HbA1c 10,32‐34 …”

“…16,18 The most common theme we observed across goal intentions of that have been shown, respectively, to be favorably and unfavorably associated with youth HbA1c. 10,[32][33][34] However, we did observe an unfavorable association between frequency of intention to elicit diabetes-specific, instrumental support (vs. emotional support) from friends or siblings and worsening glycemic control. 32,35 Existing literature on the effect of peer support on T1D self-management is mixed, and mechanisms by which the various types of peer support positively or negatively affect glycemic control have been hypothesized but not clearly elucidated or quantified.…”

“…35 The unfavorable association observed in our sample aligns with hypotheses that increased expressed intention to rely on peers may be indicative of a nascent level of youth self-reliance for selfmanagement or indicative of certain challenging family contexts, both of which might contribute to self-management difficulties and poorer glycemic control. [32][33][34] Moreover, the direction of this observed association highlights the more general need for further exploration of the relevance to the adolescent age group of certain empowerment-based diabetes self-management counseling principles developed from research with adults, especially those that recommend counselors invite participants to include family and social support "as desired" in diabetes self-management, and "affirm that patients are experts on their own support needs". 14 Despite the inclusion of physical activity and healthy eating in the "core" self-care behaviors promoted by the American Association of Diabetes Educators (AADE) and other clinical guidelines, these areas did not appear frequently enough in the self-directed goal setting intentions of our sample of youth to emerge as independent focus areas, and were thus collapsed into the "other diabetes-specific" goal focus area.…”

The effects of family functioning and resilience on self‐management and glycaemic control among youth with type 1 diabetes

“…Previous studies have provided some insights regarding the negative effects of family dysfunction on behavioural and health‐related outcomes in youth with T1D. For example, family conflict and less parental monitoring negatively influence self‐management and glycaemic control (Hilliard et al, ; Vaid, Lansing, & Stanger, ). In this study, we tried to identify the roles of positive family relationships.…”