Abstract
Adherence and glycemic control usually decrease during adolescence and family relationships influence diabetes outcomes. This study analyzed the interaction effect of adolescents’ family support, age, and gender in the relationship between adherence and glycemic control in adolescents with Type 1 Diabetes. The sample included 100 adolescents with Type 1 Diabetes and one of their parents during a routine endocrinology appointment. Adolescents answered the Self-Care Inventory—Revised, the Diabetes Family Behavior Scale and were also assessed on the glycosylated hemoglobin. The three-way interaction between adherence, family support, and adolescents’ age/gender was both negatively significant and explained 24.12% and 22.02% of the variance, respectively. Higher family support, being female, and younger age moderated the relationship between adherence and glycemic control. According to results, it is important that intervention programs provide negotiation skills, according to adolescent’s age and gender in the process of transferring diabetes management responsibility in order to promote better adherence to diabetes self-care, glycemic control, and prevent family conflicts regarding diabetes management.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Almeida, A. C., & Pereira, M. G. (2010). Self-care inventory-revised (SCI-R). Braga: Research Version of University of Minho.
Almeida, P., & Pereira, M. G. (2011). Escala comportamental de suporte social e familiar para adolescentes com diabetes (DFBS). Psicologia, Saúde & Doenças,12, 55–75.
Armstrong, B., Mackey, E. R., & Streisand, R. (2011). Parenting behavior, child functioning, and health behaviors in preadolescents with Type 1 Diabetes. Journal of Pediatric Psychology,36, 1052–1061. https://doi.org/10.1093/jpepsy/jsr039.
Borus, J. S., & Laffel, L. (2010). Adherence challenges in the management of Type 1 Diabetes in adolescents: Prevention and intervention. Current Opinion in Pedriatics,22, 405–411. https://doi.org/10.1097/MOP.0b013e32833a46a7.
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, 171–184. https://doi.org/10.1093/jpepsy/jsh019.
Daoud, J. I. (2017). Multicollinearity and regression analysis. Journal of Physics: Conference Series,949, 1–7. https://doi.org/10.1088/1742-6596/949/1/012009.
Dawson, J. F. (2014). Moderation in management research: What, when, why and how. Journal of Business and Psychology,29, 1–19. https://doi.org/10.1007/s10869-013-9308-7.
DiMeglio, L. A., Acerini, C. L., Codner, E., Craig, M. E., Hofer, S. E., Pillay, K., et al. (2018). Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatric Diabetes,19, 105–114. https://doi.org/10.1111/pedi.12737.
Donaghue, K. C., Marcovechio, M. L., Wadwa, R. P., Chew, E. Y., Wong, T. Y., Calliari, L. E., et al. (2018). Microvascular and macrovascular complications in children and adolescents. Pediatric Diabetes,19, 262–274. https://doi.org/10.1111/pedi.12742.
Ellis, D. A., Podolski, C.-L., Frey, M., Naar-King, S., Wang, B., & Moltz, K. (2007). The role of parental monitoring in adolescents health outcomes: Impact on regimen adherence in youth with Type 1 Diabetes. Journal of Pediatric Psychology,32, 907–917. https://doi.org/10.1093/jpepsy/jsm009.
Greening, L., Stoppelbein, L., & Reeves, C. B. (2010). A model for promoting adolescents’ adherence to treatment for Type 1 Diabetes mellitus. Children’s Health Care,35, 247–267. https://doi.org/10.1207/s15326888chc3503_4.
Hamilton, J., & Daneman, D. (2002). Deteriorating diabetes control during adolescence: Physiological or psychosocial? Journal of Pediatric Endocrinology and Metabolism,15, 115–126. https://doi.org/10.1515/JPEM.2002.15.2.115.
Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Publications. https://doi.org/10.1111/jedm.12050.
Helgeson, V. S., Reynolds, K. A., Siminerio, L., Escobar, O., & Becker, D. (2008). Parent and adolescent distribution of responsibility for diabetes self-care: Links to health outcomes. Journal of Pediatric Psychology,33, 497–508. https://doi.org/10.1093/jpepsy/jsm081.
Hochhausser, C. L., Rapaport, R., Shemesh, E., Schmeidler, J., & Chemtob, C. M. (2008). Age at diagnosis, gender, and metabolic control in children with Type 1 Diabetes. Pediatric Diabetes,9, 303–307. https://doi.org/10.1111/j.1399-5448.2008.00395.x.
Jackson, Y., & Warren, J. S. (2000). Appraisal, social support, and life events: Predicting outcome behavior in school-age children. Child Development,71, 1441–1457. https://doi.org/10.1111/1467-8624.00238.
Jaser, S. S., & Grey, M. (2010). A pilot study of observed parenting and adjustment in adolescents with Type 1 Diabetes and their mothers. Journal of Pediatric Psychology,35, 738–747. https://doi.org/10.1093/jpepsy/jsp098.
Korbel, C. D., Wiebe, D. J., Berg, C. A., & Palmer, D. L. (2007). Gender differences in adherence to Type 1 Diabetes management across adolescence: The mediating role of depression. Children’s Health Care,36, 83–98. https://doi.org/10.1080/02739610701316936.
La Greca, A. M., & Bearman, K. J. (2002). The diabetes social support questionnaire-family version: Evaluating adolescents’ diabetes-specific support from family members. Journal of Pediatric Psychology,27, 665–676. https://doi.org/10.1093/jpepsy/27.8.665.
Lewin, A. B., Heidgerken, A. D., Geffken, G. R., Williams, L. B., Storch, E. A., Gelfand, K. M., et al. (2006). The relation between family factors and metabolic control: The role of diabetes adherence. Journal of Pediatric Psychology,31, 174–183. https://doi.org/10.1093/jpepsy/jsj004.
McKelvey, J., Waller, D. A., North, A. J., Marks, J. F., Schreiner, B., Travis, L. B., & Murphy, J. N. (1993). Reliability and validity of the Diabetes Family Behavior Scale (DFBS). The Diabetes Educator,19, 125–132. https://doi.org/10.1177/014572179301900206.
Moore, S. M., Hackworth, N. J., Hamilton, V. E., Northam, E., & Cameron, F. (2013). Adolescents with Type 1 Diabetes: Parental perceptions of child health and family functioning and their relationship to adolescent metabolic control. Health and Quality of Life Outcomes,11, 1–8. https://doi.org/10.1186/1477-7525-11-50.
Naar-King, S., Idalski, A., Ellis, D., Frey, M., Templin, T., Cunningham, P. B., et al. (2006). Gender differences in adherence and metabolic control in urban youth with poorly controlled Type 1 Diabetes: The mediating role of mental health symptoms. Journal of Pediatric Psychology,31, 793–802. https://doi.org/10.1093/jpepsy/jsj090.
Neylon, O. M., O’Connel, M. A., Skinner, T. C., & Cameron, F. J. (2013). Demographic and personal factors associated with metabolic control and self-care in youth with Type 1 Diabetes: A systematic review. Diabetes/Metabolism Research and Reviews,29, 257–272. https://doi.org/10.1002/dmrr.2392.
Patterson, C. C., Harjutsalo, V., Rosenbauer, J., Neu, A., Cinek, O., Slrivarhaug, E., et al. (2019). Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centers in the 25 year period 1989–2013: A multicenter prospective registration study. Diabetologia, 62, 408–417. https://doi.org/10.1007/s00125-018-4763-3.
Pendley, J. S., Kasmen, L. J., Miller, D. L., Donze, J., Swenson, C., & Reeves, G. (2002). Peer and family support in children and adolescents with Type 1 Diabetes. Journal of Pediatric Psychology,27, 429–438. https://doi.org/10.1093/jpepsy/27.5.429.
Pereira, M. G., Almeida, A. C., Rocha, L., & Leandro, E. (2011). Predictors of adherence, metabolic control and quality of life in adolescents with Type 1 Diabetes. In C.-P. Liu (Ed.), Type 1 Diabetes—Complications, pathogenesis, and alternative treatments (pp. 119–140). Rijeka: InTech.
Pereira, M. G., Berg-Cross, L., Almeida, P., & Machado, J. C. (2008). Impact of family environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes. International Journal of Behavioral Medicine,15, 187–193. https://doi.org/10.1080/10705500802222436.
Raile, K., Galler, A., Hofer, S., Herbst, A., Dunstheimer, D., Busch, P., et al. (2007). Diabetic nephropathy in 27,805 children, adolescents, and adults with Type 1 Diabetes. Effect of diabetes duration, A1C, hypertension, dyslipidemia, diabetes onset, and sex. Diabetes Care,30, 2523–2528. https://doi.org/10.2337/dc07-0282.
Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman, F., Laffel, L., et al. (2005). Care of children and adolescents with Type 1 Diabetes. Diabetes Care,28, 186–212. https://doi.org/10.2337/diacare.28.1.186.
Simmons, K. M., & Michels, A. W. (2015). Type 1 Diabetes: A predictable disease. World Journal of Diabetes,6, 380–390. https://doi.org/10.4239/wjd.v6.i3.380.
Sociedade Portuguesa de Diabetologia [Portuguese Society of Diabetology]. (2016). Annual Report of the National Diabetes Observatory. Diabetes: Factos e Números—O Ano de 2015. Lisboa (Portugal).
Stattin, H., & Kerr, M. (2000). Parental monitoring: A reinterpretation. Child Development,71, 1072–1085. https://doi.org/10.1111/1467-8624.00210.
Weinger, K., Butler, H. A., Welch, G. W., & La Greca, A. M. (2005). Measuring diabetes self-care. A psychometric analysis of the self-care inventory-revised with adults. Diabetes Care,28, 1346–1352. https://doi.org/10.2337/diacare.28.6.1346.
Whittemore, R., Jaser, S., Guo, J., & Grey, M. (2010). A conceptual model of childhood adaptation to Type 1 Diabetes. Nursing Outlook,58, 242–251. https://doi.org/10.1016/j.outlook.2010.05.001.
Williams, C., Sharpe, L., & Mullan, B. (2014). Developmental challenges of adolescents with Type 1 Diabetes: The role of eating attitudes, family support and fear of negative evaluation. Psychology, Health and Medicine,19, 324–334.
Wysocki, T., Nansel, T. R., Holmbeck, G. N., Chen, R., Laffel, L., Anderson, B. J., et al. (2009). Collaborative involvement of primary and secondary caregivers: Associations with youths’ diabetes outcomes. Journal of Pediatric Psychology,34, 869–881. https://doi.org/10.1093/jpepsy/jsn136.
Zhang, L., Ellis, D. A., Naar-King, S., Moltz, K., Carcone, A. I., & Dekelbab, B. (2016). Effects of socio-demographic factors on parental monitoring, and regimen adherence among adolescents with Type 1 Diabetes: A moderation analysis. Journal of Child and Family Studies,25, 176–188. https://doi.org/10.1007/s10826-015-0215-6.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ana C. Almeida, M. Engrácia Leandro, and M. Graça Pereira declare that there is no conflict of interest.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of the two Portuguese hospitals (Process no. 68-CHLC) and with the 1964 Helsinki Declaration and its later amendments.
Informed Consent
All parents and adolescents signed an informed consent to participate in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Almeida, A.C., Leandro, M.E. & Pereira, M.G. Adherence and Glycemic Control in Adolescents with Type 1 Diabetes: The Moderating Role of Age, Gender, and Family Support. J Clin Psychol Med Settings 27, 247–255 (2020). https://doi.org/10.1007/s10880-019-09662-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-019-09662-y