Skip to main content
SpringerLink
Log in

Impact of family environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background: Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. Purpose: To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. Method: This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. Results: This study’s results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. Conclusion: The results highlight the importance of studying family variables in adolescents’ diabetes care within the wider cultural factors affecting the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alemzadeh, R., & Wyatt, D. T. (2004). Diabetes mellitus in children. In Nelson Textbook of Pediatrics, 17th ed. Behrman, R. E., Kliegman, R. M., and Jenson, H. B. (Eds), (pp. 1947–1972). Philadelphia: W.B. Saunders Co.

    Google Scholar 

  • Almeida, P., & Pereira, M. G. (2003). Self-report questionnaire on adherence. Experimental version. Department of Psychology, Braga, Portugal: University of Minho.

    Google Scholar 

  • Anderson, B. J., Brackett, J., Finkelstein, D., & Laffel, L. (1997). Parental involvement in diabetes management tasks: Relationship to blood glucose monitoring and metabolic control in adolescents with insulin-dependent diabetes-mellitus. The Journal of Pediatrics, 130(2), 257–265.

    Article  PubMed  Google Scholar 

  • Barakat, L. P., & Kazak, A. E. (1999). Family issues. In R. T. Brown (Ed.), Cognitive aspects of chronic illness in children. New York: Guilford Press.

    Google Scholar 

  • Cohen, D. M., Lumley, M. A., Naar-King, S., Partridge, T., & Cakan, N. (2004). Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with type 1 diabetes: A prospective study. Journal of Pediatric Psychology, 29(3), 171–184.

    Article  PubMed  Google Scholar 

  • Diabetes Control and Complications Trial Research Group (DCCT). (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329, 977–986.

    Article  Google Scholar 

  • Dickenson, L. M., Ye, X., Sack, J., & Hueston, W. (2003). General quality of life in youth with type 1 diabetes: Relationship to patient management and diabetes-specific family conflict. Diabetes Care, 26, 3067–3073.

    Article  Google Scholar 

  • Donnelly, L. A., Morris, A. D., & Evans, J. M. (2007). Adherence to insulin and its association with glycemic control in patients with type 2 diabetes. Quarterly Journal of Medicine, 100(6), 345–350.

    Google Scholar 

  • Drotar, D. (1997). Relating parent and family functioning to the psychological adjustment of children with chronic conditions: What have we learned? What do we need to know? Journal of Pediatric Psychology, 22(2), 159–166.

    Google Scholar 

  • Garay-Sevilla, M. E., Nava, L. E., Malacara, J. M., Huerta, R., de Leon, J. D., Mena, A., et al. (1995). Adherence to treatment and social support in patients with NIDDM. Journal of Diabetics Complications, 9(2), 81–86.

    Article  Google Scholar 

  • Gillibrand, R. A., & Stevenson, J. (in press). The role of partner relationships in the young person’s adherence to the diabetes self-care regime. International Journal of Behavioral Medicine, (Pages: under review).

  • Glasgow, R. (1991). Compliance to diabetes Regimens: Conceptualization, complexity and determinants. In J. A. Cramer & Spilker: Patient Compliance in Medical Practice and Clinical Trial (pp. 123–137). Raven Press, Lda. New York.

    Google Scholar 

  • Glasgow, R., McCaul, K. D., & Schaffer, L.C. (1987). Self care behaviours and glycemic Control in type 1 Diabetes. Journal of Chronic Disease, 40, 65–77.

    Article  Google Scholar 

  • Graffar, M. (1956). Une methode de classification socialle-échantillions de population. Courrier, 6, 445–449.

    Google Scholar 

  • Grey, M., Boland, E., Yu, C., Sullivan-Bollyai, A., & Tamborlane, W. V. (1998). Personal and family factors associated with quality of life in adolescents with diabetes. Diabetes Care, 212(6), 909–914.

    Article  Google Scholar 

  • Guttmann-Bauman, I., Flaherty, B. P., Strugger, M., & McEvoy, R. C.(1998). Metabolic control and quality of life self-assessment in adolescents with IDDM. Diabetes Care, 21(6), 915–918.

    Article  PubMed  Google Scholar 

  • Hamlet, K. W., Pellegrini, D. S., & Katz, K. S. (1992). Childhood chronic illness as a family stressor. Journal of Pediatric Psychology, 17, 33–47.

    Article  Google Scholar 

  • Hanson, C., Cigrang, J., Harris, M., Carle, D., Relyea, G., & Burghen, G. (1989b). Coping styles in youths with insulin-dependent diabetes mellitus. Journal of Consulting and Clinical Psychology, 57, 644–651.

    Article  PubMed  Google Scholar 

  • Hanson, C. L., Henggeler, S. W., & Burghen, G. A. (1987). Social competence and parental support as mediators of the link between stress and metabolic control in adolescents with insulin-dependent diabetes mellitus. Journalof Consulting and Clinical Psychology, 55, 529–533.

    Article  Google Scholar 

  • Hanson, C., Henggeler, S. W., Burghen, G., & Moore, M. (1989a). Family system variable and the health status of adolescents with insulin-dependent diabetes mellitus.Health Psychology, 8(2), 239–253.

    Article  PubMed  Google Scholar 

  • Hoey, H., Aanslot, H.-J., Chiarelli, F., Daneman, D., Danne, T., Dorchy, H., et al. (2001). Good metabolic control is associated with better quality of life in 2101 adolescents with type 1 diabetes. Diabetes Care, 24(11), 1923–1928.

    Article  PubMed  Google Scholar 

  • Horner, S. D. (1997). Uncertainty in mothers’ care for their ill children. Journal of Advanced Nursing, 26(4), 658–663.

    Article  PubMed  Google Scholar 

  • Injersoll, G., & Marrero, D. (1991). A modified quality of life measure for youths: Psychometric properties. The Diabetes Educator, 17(2), 114–118.

    Article  Google Scholar 

  • ISPAD & IDF (2000). ISPAD consensus guidelines for the management of type 1 diabetes mellitus in children and adolescents. Medical Forum International, The Netherlands.

  • ISPAD, IDF, & WHO (St. Vincent & Kos Declarations). (1995). Consensus guidelines for the management of insulin-dependent (type 1) diabetes mellitus (IDDM). In Childhood and adolescence. London: Freund.

    Google Scholar 

  • Jacobson, A. M., Hauser, S. T., Lavori, P., Wolfsdorf, J. I., Herskowitz, R. D., Miley, J. E.,et al. (1990). Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up. I. The influence of patient coping and adjustment. Journal of Pediatric Psychology, 15(4), 511–526.

    Article  PubMed  Google Scholar 

  • Johnson, S. B. (1994). Health behavior and health status: Concepts, methods and applications. Journal of Pediatric Psychology, 19(2), 129–142.

    Article  PubMed  Google Scholar 

  • Johnson, S. B., Freund, A., Silverstein, J., Hansen, C., & Malone, J. (1990). Adherence-health status relationships in childhood diabetes. Health Psychology, 9, 606–631.

    Article  PubMed  Google Scholar 

  • Kilo, C., & Williamson, J. R. (1987). Diabetes: The facts that let you regain control over your life. New York: Wiley.

    Google Scholar 

  • Kovacs, M., Brent, D., Steinberg, T. F., Paulauskas, S., & Reid, J. (1986). Children’s self-reports of psychologic adjustment and coping strategies during the first years of insulin-dependent diabetes mellitus. Diabetes Care, 9, 472–479.

    Article  PubMed  Google Scholar 

  • Krapek, K., King, K., Warren, S., George, K., Caputo, D., Mihe-lich, K., et al. (2004). Medication adherence and associated hemoglobin A1c in type 2 diabetes. The Annals of Pharma-cotherapy, 38(9), 1357–1362.

    Article  Google Scholar 

  • La Greca, A. M., & Thomson, K. M. (1998). Family and friend support for adolescents with diabetes. Análise Psicológica, 1 (XVI), 101–113.

    Google Scholar 

  • La Greca, A. M., Auslander, W. F, Greco, P., Spetter, D., Fisher, E. B., & Santiago, J. V. (1995). I get by a little help from my family and friends: Adolescent’s support for diabetes care. Journal of Pediatric Psychology, 20, 449–476.

    Article  PubMed  Google Scholar 

  • Leonard, B. J., Garwick, A., & Adwan, J. Z. (2005). Adolescent’s perceptions of parental roles and involvement in diabetes management. Journal of Pediatric Nursing, 20(6), 405–414.

    Article  PubMed  Google Scholar 

  • Leonard, B. J., Savik, K., Plumbo, P. M., & Christensen, R. (2002). Psychosocial factors associated with levels of metabolic control in youth with type 1 diabetes. Journal of Pediatric Nursing, 17(1), 28–37.

    Article  PubMed  Google Scholar 

  • Lewin, A., Heidgerken, A., Geffken, G., Williams, L., Storch, E., Gelfand, K., & Silverstein, J. (2006). The relation between family factors and metabolic control: The role of diabetes adherence. Journal of Pediatric Psychology, 31(2), 174–183.

    Article  PubMed  Google Scholar 

  • Martin, M. T., Miller-Johnson, S., Kitzmann, K. M., & Emery, R. E. (1998). Parent-child relationships and insulin dependent diabetes mellitus: Observational ratings of clinically relevant dimensions. Journal of Family Psychology, 12(1), 102–111.

    Article  Google Scholar 

  • McCubbin, M. A., & McCubbin, H. I. (1993). Families coping with illness: The resilience model of family stress, adjustment, and adaptation. In C. B. Danielson, B. Hamel-Bissell, & P. Winstead-Fry (Eds.), Families, health, and illness: Perspectives on coping and intervention. St. Louis, MO: Mosby-Year Book.

    Google Scholar 

  • Mckelvey, J., Walter, D., North, A. J., Marks, J. F., Schreiner, B., Travis, L. B., et al. (1993). Reliability and validity of the Diabetes Family Behavior Scale (DFBS). The Diabetes Educator, 19(2), 125–132.

    Article  PubMed  Google Scholar 

  • Moos, R. H., & Moos, B. S. (1986). Family environment scale manual. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Palardy, N., Greening, L., Ott, J., Holderby, A., & Atchinson, J. (1998). Adolescents’ health attitudes and adherence to treatment for insulin-dependent diabetes mellitus. Developmental and Behavioral Pediatrics, 19(1), 31–37.

    Article  Google Scholar 

  • Pinar, R., Erslanoglu, I., Isguven P., Cizmeci F., & Gunoz H. (2003). Self-efficacy and its interrelation with family environment and metabolic control in Turkish adolescents with type 1 diabetes. Pediatric Diabetes, 4(4), 168–173.

    Article  PubMed  Google Scholar 

  • Santiago, J. V. (1984). Effect of treatment on the long term complications of IDDM. Behavioral Medicine Update, 6,(1), 26–31.

    Google Scholar 

  • Sarafino, E. P. (1990). Health psychology: Byopsicossocial Interactions. New York, John Wiley & Sons.

    Google Scholar 

  • Seiffe-Krenke, I. (1998). Psychological adjustment of adolescents with diabetes: Functional or dysfunctional for metabolic control? Journal of Pediatric Psychology, 23(5), 313–322.

    Article  Google Scholar 

  • Silver, E. J., Stein, R. E. K., & Dadds, M. R. (1996). Moderating effects of family structure on the relationship between physical and mental health in urban children with chronic illness. Journal of Pediatric Psychology, 21(1), 43–56.

    Article  PubMed  Google Scholar 

  • Sperling, A. M. (1996). Diabetes mellitus. In W. E. Nelson, R. M. Behrman, & A. M. Arvin (Ed.), Nelson textbook of pediatrics (15th ed.). Philadelphia: WB Sanders.

    Google Scholar 

  • Toobert, D. J., & Galasgow, R. (1996). Assessing diabetes self-management: The summary of diabetes self care activities questionnaire. In C. Bradley (Ed.). Handbook of psychology and diabetes. London: Harwood Academic.

    Google Scholar 

  • Warren, L., & Hixenbaugh, P. (1996). The role of health beliefs and locus of control on regimen adherence from a life-span perspective. Proceedings of the British Psychological Society, 5, 17.

    Google Scholar 

  • Williams, G. C., Freedman, Z. R., & Deci, E. L. (1998). Supporting Autonomy to motivate patients with diabetes for glucose control. Diabetes Care, 21(10), 1644–1651.

    Article  PubMed  Google Scholar 

  • Wilson, W., Ary, D. V., Biglan, A., Glasgow, R. E., Toober, D. J., & Campbell, D. R. (1986). Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin dependent diabetes mellitus. Diabetes Care, 9, 614–622.

    Article  PubMed  Google Scholar 

  • Wing, R. R., Nowalk, M. P., & Guare, J. C. (1988). Diabetes mellitus. In E. A. Bleckman & K. D. Bownell (Eds.), Handbook of behavioral medicine for women. New York: Pergamon.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Minho, Braga, Portugal

    M. Graça Pereira & J. Cunha Machado

  2. Howard University, Washington, DC

    Linda Berg-Cross

  3. S. João’s Hospital, Oporto, Portugal

    Paulo Almeida

Authors
  1. M. Graça Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda Berg-Cross
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paulo Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Cunha Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Graça Pereira.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Graça Pereira, M., Berg-Cross, L., Almeida, P. et al. Impact of family environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes. Int. J. Behav. Med. 15, 187–193 (2008). https://doi.org/10.1080/10705500802222436

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1080/10705500802222436

Key words

Search

Navigation