Social competence and parental support as mediators of the link between stress and metabolic control in adolescents with insulin-dependent diabetes mellitus.

Abstract

This study investigated whether the link between stress and metabolic control in adolescents with insulin-dependent diabetes mellitus (IDDM) is direct or indirect and whether this association is mediated by either social competence or parental support. Subjects included 104 adolescents with IDDM and their mothers. Measures of adherence, life stress, social competence, and parental support were obtained during the assessment session, and metabolic control was determined by averaging the adolescent's glycosylated hemoglobin levels during the previous year. Multiple regression analysis revealed that stress was directly associated with metabolic control, independent of the link between adherence and metabolic control. Multiple regression analysis also showed that social competence buffered the negative association between stress and metabolic control. Moreover, parental support was directly linked with adherence, and adolescent age was indirectly linked with adherence through its association with parental support. These findings are consistent with the developmental transitions that accompany adolescence.

Family Conflict and Diabetes Management in Youth: Clinical Lessons From Child Development and Diabetes Research

“…3,9,12 To summarize these studies' findings: • Higher family cohesion, parental warmth (defined as support and affection), and an "authoritative" style of parenting (which involves being engaged with the child with warmth while limit-setting and having high maturity demands with low levels of coercive control) are related to higher levels of adherence and cooperation by the child or adolescent with the tasks of diabetes treatment and to better glycemic control. • Higher general family conflict, parental restrictiveness, and criticism and an "authoritarian" style of parenting (high levels of maturity demands with high levels of coercive control) are related to lower levels of adherence and cooperation by the child or adolescent with the tasks of diabetes management and to poorer glycemic control.…”

“…1 Moreover, it is well documented that higher levels of conflict in the family correlate with lower levels of child adherence to the diabetes treatment regimen. [2][3][4][5][6][7][8] General family conflict has been demonstrated to relate to adherence in youth with type 1 diabetes in both cross-sectional studies 3,4,8 and longitudinal, prospective research. 9 In a study of parenting, child development, and diabetes adherence and control, Miller-Johnson et al 10 demonstrated that ratings of increased conflict were directly related to diabetes adherence problems and poorer blood glucose control.…”

Coping Skills Training for Youths With Diabetes

“…17 In adolescents with or at risk for diabetes, social competence has been associated with better emotional well-being, 15 better ability to manage stress, and better metabolic control. 18,19 Coping is a complex process that can be defined as "constantly chang-ing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person." 20 According to Lazarus and Folkman, 20 the first step in coping is cognitive appraisal, which is crucial to the impact of a particular disease on a particular child.…”

Adolescent views of diabetes-related parent conflict and support: a focus group analysis

“…This developmental task may be more complicated for adolescents with type 1 diabetes because, at this time in their lives, both metabolic control and treatment adherence often deteriorate [7][8][9][10][11][12][13][14], and less parental involvement in diabetes care has been associated with poorer diabetes outcomes [8,15]. In contrast, adolescents whose parents remain involved in self-care activities show better adherence and more effective glycemic control [7,16].…”