Diabetes-specific Family Conflict Research Articles

Relationship between parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent/family wellbeing and glycaemic control.

This study investigated the relationship between parent-reported degree of openness and extent of problems in parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent and family wellbeing and adolescent glycaemic control. A cross-sectional quantitative survey was conducted. Parents completed measures of parent-adolescent communication, parent monitoring of diabetes care, diabetes family responsibility, parent knowledge of diabetes care, parent activation, parent diabetes distress, and diabetes family conflict. In total, 146 parents/guardians (121 mothers, mean age 46.56 years, SD 5.18) of adolescents aged 11-17 years (mean age 13.9 years, SD 1.81) with Type 1 diabetes completed the survey. Open parent-adolescent communication was significantly correlated to adolescents' voluntarily disclosing diabetes-specific information to their parents more frequently, increased parental knowledge of their adolescent's diabetes care completion, parents feeling more capable and willing to take action in relation to their adolescent's diabetes health, lower levels of diabetes-related parental distress, less diabetes-specific family conflict, and optimal glycaemic control. Parent-adolescent communication has an important role to play in Type 1 diabetes healthcare management and psychosocial wellbeing during adolescence. Optimising open parent-adolescent communication represents a potentially useful target for interventional research and should be considered by healthcare professionals during healthcare encounters.

Updated Psychosocial Surveys With Continuous Glucose Monitoring Items for Youth With Type 1 Diabetes and Their Caregivers.

We added items relevant to continuous glucose monitoring (CGM) to the Diabetes Family Conflict Scale (DFC), Diabetes Family Responsibility Questionnaire (DFR), and Blood Glucose Monitoring Communication Questionnaire (GMC) and evaluated the psychometric properties of the updated surveys. Youth with type 1 diabetes who recently started CGM and their parents completed the updated surveys and additional psychosocial surveys. Medical data were collected from self-reports and review of the medical record. Youth (N = 114, 49% adolescent girls) were aged 13.3 ± 2.7 years and had mean glycated hemoglobin (HbA1c) 7.9 ± 0.9%; 87% of them used pump therapy. The updated surveys demonstrated high internal consistency (DFC youth: α = .91, parent: α = .81; DFR youth: α = .88, parent: α = .93; and GMC youth: α = .88, parent: α = .86). Higher youth and parent DFC scores (more diabetes-specific family conflict) and GMC scores (more negative affect related to glucose monitoring) were associated with more youth and parent depressive symptoms (r = 0.28-0.60, P ≤ .003), more diabetes burden (r = 0.31-0.71, P ≤ .0009), more state anxiety (r = 0.24 to r = 0.46, P ≤ .01), and lower youth quality of life (r = -0.29 to -0.50, P ≤ .002). Higher youth and parent DFR scores (more parent involvement in diabetes management) were associated with younger youth age (youth: r = -0.76, P < .0001; parent: r = -0.81, P < .0001) and more frequent blood glucose monitoring (youth: r = 0.27, P = .003; parent: r = 0.35, P = .0002). The updated DFC, DFR, and GMC surveys maintain good psychometric properties. The addition of CGM items expands the relevance of these surveys for youth with type 1 diabetes who are using CGM and other diabetes technologies.

Daily diabetes-specific family conflict, problems, and blood glucose during adolescence.

Diabetes-related family conflict is widely regarded as a risk factor for diabetes outcomes, yet it has not been examined on a daily basis. Parental acceptance may attenuate the degree to which family conflict is associated with diabetes outcomes. The present study examined (a) within- and between-person fluctuations in diabetes problems and family conflict, (b) within- and between-person links between conflict and blood glucose (BG) mean, and (c) whether parental acceptance moderated these associations. One hundred eighty adolescents (Mage = 12.92 years) with T1D completed a 14-day diary measuring diabetes problems, conflict with mother, conflict with father, and parental acceptance at the end of each day. Daily average BG values were calculated from glucometer readings. Higher diabetes problems on average across the 14-day diary were associated with more average conflict with mothers (between-person), but daily fluctuations in the number of diabetes problems were not related to daily conflict (within-person). Adolescents with higher conflict with mothers and fathers on average across the 14 days had higher BG means (between-person); however, on days when adolescents reported higher conflict, they had greater risk for low BG (within-person). Daily parental acceptance did not moderate associations between problems and conflict nor conflict and BG mean. This study was the first to examine daily diabetes-specific conflict with mothers and fathers during adolescence. The number of diabetes problems did not predict daily conflict. Fluctuations in daily conflict were associated with greater risk for low BG, underscoring the need for future research examining in-the-moment relations among conflict and BG extremes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

1017-P: Relationship between Parent Fear of Hypoglycemia and Diabetes Family Conflict in Adolescents with Type 1 Diabetes

Few studies have examined the relationship between diabetes-related family conflict and parent fear of hypoglycemia (FOH) in adolescents, thus the current research evaluated this connection. This study specifically examined three subdimensions of FOH which parents of children with diabetes may experience: maintaining blood glucoses higher than medical recommendations, worrying about and/or feeling helplessness about preventing low blood glucoses, and worrying about social consequences associated with low blood glucoses. At the baseline visit of an RCT aimed at improving health outcomes of youth with elevated A1C (9-12% in the last year) , caregivers completed the Diabetes Family Conflict Scale and the Parent Hypoglycemia Fear Survey. N=1child-caregivers dyads (child age=14.7±1.9 years, T1D duration=6.5±3.4 years, A1C=9.9±1.6%; 53% female; 77% continuous glucose monitor; 82% insulin pump) . In three separate regression models, no child demographic or T1D clinical characteristics other than A1C were associated with family conflict. After controlling for A1C, only Worry/Helplessness About Low Blood Glucose (b=0.182; p=0.025) and Worry About Negative Social Consequences (b=0.532; p=0.008) significantly predicted parent-reported family conflict; Maintain High Blood Glucose (b=0.082; p=0.73) was not significant. This is the first study to demonstrate that caregivers’ worry about their adolescents having low blood glucoses is associated with diabetes-specific family conflict- a common adherence barrier for adolescents with T1D and their families. This finding supports screening caregivers for fear of hypoglycemia and incorporating into treatment when providing intervention for families with high levels of conflict. Important next steps include dyadic data analysis to understand how fear of hypoglycemia symptoms among child-caregiver dyads affect family conflict. Disclosure H.Manis: Other Relationship; Abbott Diabetes. H.K.O'donnell: None. G.T.Alonso: None. S.Majidi: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)

280-OR: Updated Diabetes Family Conflict Scale (DFC) Includes Continuous Glucose Monitoring (CGM) Items

Introduction: With increased CGM use in youth with T1D, it is timely to assess diabetes-specific family conflict related to CGM use. We aimed to evaluate the psychometric properties of an updated DFC measure that includes CGM items. Methods: Youth with T1D and their parents completed youth and parent versions, respectively, of the DFC that included 6 CGM-specific items (e.g., responding to CGM alarms) . Higher scores indicate more conflict. Item-to-total correlations and Cronbach’s α assessed internal consistency; correlations determined concurrent and predictive validity. Results: The sample comprised 1youth (51% male) aged 13.2±2.7 years, with T1D duration 6.6±3.5 years. The final survey had 16 items after removal of those with outdated features, low response variability, or low item-to-total correlation. Cronbach’s α was .91 for youth and .81 for parents. Youth and parent scores were highly correlated (r=.48, p&amp;lt;.0001) . Higher DFC scores were associated with younger youth age (youth: r=-.23, p=.02; parent: r=-.27, p=.004) . Higher youth and parent DFC scores were also associated with adverse psychosocial outcomes: more depressive symptoms (youth: r=.38, p&amp;lt;.0001; parent: r=.35, p=.0002) , more diabetes burden (youth: r=.31, p=.0008; parent: r=.44, p&amp;lt;.0001) , more anxiety traits (youth: r=.23, p=.02; parent: r=.45; p&amp;lt;.0001) , lower youth general quality of life (QoL) (youth: r=-.30, p=.002; parent: r=-.45, p&amp;lt;.0001) and lower youth diabetes-specific QoL (youth: r=-.21, p=.02; parent: r=-.44, p&amp;lt;.0001) . Higher youth and parent DFC scores were associated with lower CGM satisfaction (youth: r=-.36, p&amp;lt;.0001; parent: r=-.28, p=.004) and with less CGM use at the time of DFC scale completion (youth: r=-.33, p=.0004; parent: r=-.31, p=.001) and 3 months later (youth: r=-.19, p=.05; parent: r=-.28, p=.003) . Conclusion: The updated youth and parent DFC scales demonstrate strong psychometric properties and predictive validity and may be useful in clinical and research settings. Disclosure C.Chen: None. A.Shapira: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (P30DK036836, R01DK089349, T32DK007260)

Concordance and discordance between youth and their parents' reports of diabetes distress: The importance of youth perceptions

AimsThe purpose of this study was to examine concordance and discordance between youth and parent reports of diabetes distress (DD) and their impact on glycemic control, diabetes-specific family conflict, and diabetes task responsibility. MethodsYouth with type 1 diabetes ages 8–17 years (N = 120, 49% female) and their parents (84% mothers) completed surveys assessing DD, diabetes-specific family conflict, and family responsibility for diabetes tasks. Participants who scored below validated cut-points for DD were categorized as having low DD and above cut-points as elevated DD. Then youth/parent dyads were categorized as concordant when youth and parents both reported low DD or both reported elevated DD and discordant when one reported low DD and one reported elevated DD. ResultsAbout a quarter (26% of youth, 23% of parents) reported elevated DD; 10% of youth/parent dyads were concordant for elevated DD. However, many dyads (28%) reported discordantly (12.5% Youth Low/Parent Elevated, 16% Youth Elevated/Parent Low). A1c (p = .04) and youth-reported diabetes-specific family conflict (p = .04) were significantly higher in the Youth Elevated/Parent Low group than in the Youth Low/Parent Elevated group. ConclusionsDD can be experienced differently among youth and their parents. When this experience is discordant, youth perceptions may be important to consider.

Longitudinal associations between family conflict, parent engagement, and metabolic control in children with recent-onset type 1 diabetes

IntroductionWe prospectively investigated the associations between diabetes-related family conflict, parent engagement in child type 1 diabetes (T1D) care, and child glycated hemoglobin (HbA1c) in 127 families of school-age children who...

Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes.

To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.

Identifying HbA1c trajectories and modifiable risk factors of trajectories in 5- to 9-year-olds with recent-onset type 1 diabetes from the United States.

To explore glycated haemoglobin (HbA1c) patterns in 5- to 9-year-olds in the recent-onset period of type 1 diabetes and identify parent psychosocial factors that may predict children's HbA1c trajectory using a prospective, longitudinal design. We measured family demographics and parent psychosocial factors at baseline. We collected HbA1c levels from children every 3months for up to 30months. Deriving several features around HbA1c trends, we used k-means clustering to group trajectories and linear and logistic regressions to identify parent psychosocial predictors of children's HbA1c trajectories. The final cohort included 106 families (48 boys, mean child age 7.50±1.35years and mean diabetes duration 4.71±3.19months). We identified four unique HbA1c trajectories in children: high increasing, high stable, intermediate increasing and low stable. Compared to a low stable trajectory, increasing parent-reported hypoglycaemia fear total score was associated with decreased odds of having a high stable or intermediate increasing trajectory. Increasing parent-reported diabetes-specific family conflict total score was associated with increased odds of having a high stable or intermediate increasing trajectory. We are the first to identify distinct HbA1c trajectories in 5- to 9-year-olds with recent-onset type 1 diabetes as well as parent psychosocial factors that may predict high stable or increasing trajectories and could represent future treatment targets.

904-P: Discordance between Youth and Parent Report of Diabetes Distress in Type 1 Diabetes (T1D): The Importance of Youth Perceptions

Diabetes Distress (DD) can be experienced differently by family members living with T1D. We examined concordance and discordance between youth and parent report of DD and the relationship with youth glycemic control, diabetes-specific family conflict and parent involvement in diabetes tasks in a sample of youth starting real-time continuous glucose monitoring (CGM). Youth (N=120, 51% male) with T1D ages 8-17 years and their parents (84% mothers) completed surveys assessing DD, family conflict and parent involvement. Previously validated cut-points of &amp;gt;41 (PAID-Peds, youth) and &amp;gt;56 (PAID-PR, parents) identified clinically significant DD. Youth/parent dyads were classified as concordant when both youth and parents scored below (Youth Low/Parent Low) or above (Youth High/Parent High) the cut-points. Youth/parent dyads were classified as discordant when youth scored below and parent scored above (Youth Low/Parent High) or youth scored above and parent scored below (Youth High/Parent Low) the cut-points. Youth had a mean±SD age of 12.7±2.7 years, T1D duration 6.1±3.6 years and A1c 8.0±0.8%; 84% were pump treated. About ¼ of youth (26%) and parents (23%) reported clinically significant DD with 62% of dyads concordant for low DD, 10% concordant for high DD and 28% discordant for DD. Concordant groups did not differ significantly from discordant groups. In the 2 discordant groups, A1c and youth-reported family conflict differed significantly; A1c: 7.5±0.9% vs. 8.3±0.7% (p=.043) and family conflict: 5.6±5.1 vs. 22.9±22.0 (p=.036) in the Youth Low/Parent High and Youth High/Parent Low groups, respectively. Parent involvement did not differ across the groups. DD can be perceived differently by youth with T1D and their parents. When youth perceive high DD and parents do not, youth appear at risk for adverse outcomes, highlighting the importance of youth perceptions. Disclosure K. Wentzell: None. M. R. Fu: None. L. K. Volkening: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. Funding National Institutes of Health (R01DK089349, K12DK094721, P30DK036836)

915-P: Characteristics of Teens with T1D That Predict Family T1D Management over Time

Aim: Adolescence is challenging for T1D management. To identify families that need more support during this time, we assessed individual and family characteristics that predict adverse communication/behaviors related to T1D care. Method: Teens with T1D (N=283) and a parent (83% mothers) completed validated measures of parent involvement in care, diabetes-specific family conflict, negative affect regarding BG monitoring, and T1D self-care at 0, 6, and 12 mo. We used linear mixed models to assess how baseline characteristics (sex, age, T1D duration, A1c, BG monitoring frequency, injection vs. pump therapy, and parent education) predicted T1D behaviors over 12 months. Results: At baseline, teens (51% male, 32% non-white, 60% pump-treated) had M±SD age 15.0±1.3 years, T1D duration 6.6±3.8 years, and A1c 8.5±1.1%. Significant modifiable and non-modifiable predictors of poorer outcomes are shown (Table). Diabetes family conflict was higher in younger teens, those with higher A1c, and teens with parents without a college degree. T1D management (parent involvement, teen self-care) was poorer for older teens and those on injections. Summary: To prevent adverse family behaviors, clinicians can target modifiable factors (e.g., glycemic control, treatment modality). Clinicians can also provide support to families of teens with non-modifiable risk factors (e.g., lower parent education, younger teens with family conflict). Disclosure R. M. Wasserman: None. L. J. Tinsley: None. P. V. Commissariat: None. L. K. Volkening: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. B. Anderson: None. Funding National Institutes of Health (R01DK095273, P30DK036836); JDRF (2-SRA-2014-253-M-B)

524-P: Diabetes Device Use Linked with Lower Family Conflict in Teens with Type 1 Diabetes

Introduction: Use of hybrid closed-loop insulin delivery systems have been associated with better glycemic control and lower hemoglobin A1c (HbA1c) values, and better glycemic control is linked with less diabetes-specific family conflict among adolescents with type 1 diabetes (T1D). Little is known, however, about how the use of closed-loop systems relates to diabetes family conflict. Methods: Participants included 60 teens ages 13-17 who had been diagnosed with T1D for ≥1 year and who reported at least moderate diabetes distress (M age= 16.15±1.4, 68% white, non-Hispanic 68% female), and their parents (78% white, non-Hispanic, 78% Married, 83% female). As part of baseline data collection of an ongoing two-site trial of a behavioral intervention, parents and teens each reported on diabetes device use and diabetes-related family conflict. HbA1c values were obtained from teens’ medical records or mail-in kits. Nonparametric (Mann-Whitney) tests were conducted to examine differences between parent and teen-reported diabetes family conflict and HbA1c in relation to use of closed-loops systems. Results: Of the participants, 12 teens (20%) were using a closed-loop system. The use of closed-loop systems was associated with lower levels of parent-reported diabetes-related family conflict (z= -2.372, p=0.018). Use of closed-loop systems was also associated with lower HbA1c values (z= -2.865, p=.004). However, teens’ own report of family conflict was not significantly related to use of the closed-loop systems (z= -1.331, .183). Conclusion: Results suggest that the use of closed-loop systems is associated with both lower HbA1c and lower parent perceptions of diabetes-related family conflict. While future studies are needed to replicate these findings in larger samples and over time, our findings further support that closed-loop systems may reduce the burden of diabetes - particularly for parents - and improve both psychosocial and glycemic outcomes in families of youth with T1D. Disclosure H. R. Moore: None. S. S. Jaser: None. R. Streisand: None. H. Inverso: None. T. Morrow: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)

910-P: Psychosocial Characteristics Associated with Diabetes Device Use in Teens with T1D

Insulin pumps and CGM devices can help youth with T1D achieve better glycemic control and alleviate self-care burden. However, not all youth want to use such devices. We compared psychosocial characteristics of teens with T1D and their parents/caregivers according to teen pump use vs. non-use as well as teen CGM use vs. non-use. At baseline, teens/parents completed psychosocial surveys assessing teen depressive symptoms [CESD], disordered eating behaviors, diabetes-specific family conflict, parent involvement in diabetes care, teen self-care, diabetes burden (PAID-Ped/PR), quality of life, and major life events. Diabetes treatment data were collected by interview and EHR review every 3 months for 18 months. Teens using/starting pump or CGM at all/most visits were considered pump users or CGM users, respectively. Chi-square and t-tests compared characteristics of device (pump, CGM) users with non-users. The sample comprised 301 teens aged 13-17 with T1D (41% male); mean age was15.0±1.3 years, T1D duration 6.5±3.7 years, and A1c 8.5±1.1%. Neither age, sex, nor T1D duration was related to device use. CGM and pump non-users had less favorable survey scores than device users for many psychosocial characteristics (Table). Identifying teens with less favorable psychosocial factors may help target those at risk for device non-use, allowing timely intervention and support by clinicians when initiating diabetes technologies.View largeDownload slideView largeDownload slide DisclosureC. Chen: None. L. J. Tinsley: None. L. K. Volkening: None. B. Anderson: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc.FundingNational Institutes of Health (R01DK095273, T32DK007260, P30DK036836); JDRF (2-SRA-2014-253-M-B)

Family conflict in type 1 diabetes: Who is at risk?

Diabetes-related conflict between caregiver and child has been associated with lower quality of life, reduced treatment adherence, and higher hemoglobin A1C. The objective of this project was to identify patient and family characteristics associated with higher levels of diabetes-specific family conflict. This was a cross-sectional study. Caregivers of children aged 4- to 18-years-old with type 1 diabetes were recruited from diabetes clinics across British Columbia. Data were collected through chart reviews and patient surveys, including the Diabetes Family Conflict Scale and the Adherence in Diabetes Questionnaire. All caregivers and children ≥8-years-old were invited to complete the survey. Potential predictors were explored using univariate and multivariable linear regression models. In the unadjusted analysis, higher caregiver report of conflict (n = 196) was associated with: low family income, non-Caucasian ethnicity, missed school, older age at diagnosis, and insulin regimen (2-3 injections/day rather than multiple daily injections or pump). When all variables were adjusted for simultaneously, income, insulin regimen, one or more stay at home parent and recent hospitalization were significant. For the child report (n = 111), higher maternal education was associated with lower conflict in the unadjusted analysis and non-Caucasian ethnicity was associated with higher conflict in the adjusted analysis. This exploratory study identified possible novel associations between patient and family characteristics and diabetes-related family conflict.

Diabetes-specific family conflict and responsibility among emerging adults with type 1 diabetes.

Emerging adulthood is a transitional period for type 1 diabetes management, and aspects of family functioning such as family conflict and responsibility for diabetes management likely change following high school graduation. This study examined changes in diabetes-specific family conflict, family responsibility for diabetes management tasks, and associations with glycemic control up to 1 year after high school. Seventy-nine emerging adults with type 1 diabetes (M age = 18.09 ± .43 years; 51% female; 71% Caucasian) and their parents (73% female) completed self-report measures on diabetes-specific family conflict and family responsibility at 3 consecutive clinic visits, beginning in the spring of their senior year of high school. Hemoglobin A1c (HbA1c) was obtained from medical records. Diabetes-specific family conflict was relatively low; scores did not significantly change from baseline to Time 3. Parent responsibility for diabetes care decreased from baseline to Time 3. Higher parent- and emerging adult-reported family conflict and higher parent responsibility for diabetes care were associated with worse glycemic control (ps < .05). Parent-reported family conflict and the interaction between parent-reported family conflict and responsibility predicted HbA1c 1 year after high school. Conversely, HbA1c did not predict diabetes-specific family conflict or responsibility 1 year after high school. Findings indicate that diabetes-specific family conflict is associated with glycemic control after high school, even when emerging adults assume greater responsibility for diabetes self-care. Diabetes-specific family conflict levels were generally low and did not change over time despite this transitional period. If diabetes-specific conflict is present, it should be an important avenue for potential intervention for emerging adults with type 1 diabetes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Influence of Family Factors on the Quality of Life of Children With Diabetes Mellitus Type 1 in West Java, Indonesia: A Cross-Sectional Analytic Study

BACKGROUND: Diabetes is a chronic disease that has a negative impact on the quality of life of children. Family should be a support system to help optimize the quality of life of children with type 1 diabetes mellitus (T1DM).&#x0D; &#x0D; PURPOSE: The study aims to analyze the influence of family conflict, number of children in the family, and depression in children on the quality of life of children with T1DM.&#x0D; &#x0D; METHOD: The study employed a cross-sectional analytic design with a sample of 51 T1DM children with inclusion criteria being aged 4&amp;ndash;18 years and currently undergoing outpatient care at the hospital. The measurement of quality of life used the KINDLR instrument, which consists of versions for children and parents. Depression was measured using the Children&amp;#39;s Depression Inventory and diabetes-specific family conflict using the Revised Diabetes Family Conflict Scale. Multivariate analysis with multiple linear regression was performed to obtain a prediction model for the quality of life of children with T1DM.&#x0D; &#x0D; RESULTS: The mean total scores of the quality of life for the children&amp;rsquo;s and parents&amp;rsquo;versionswere76.39 &amp;plusmn; 13.27 and 78.64 &amp;plusmn; 9.38, respectively. The mean score of diabetes-specific family conflictwas31.03 &amp;plusmn; 9.28 with a min-max score of 19&amp;ndash;50. Quality of life of children was not different between male and female (p = &amp;gt; .05). As many as 40% of the children experienced depression with ameanscoreof 8.28 &amp;plusmn; 5.02. The quality of life of children for the parent-rated version had a positive correlation with the quality of life of children with r = .463 at p= .002. Depression was negatively correlated with the quality of life of children with r = -.287 at p =.025. Multivariate analysis shows interactionsbetweenfamily conflict and number of children in the family (p = .017) and depression (p = .050), both as the main factors affecting the quality of life of children.&#x0D; &#x0D; CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Family conflict and the number of children in the family and depression in children were predictors of quality of life in children with T1DM. The results of the study have implications for the importance of nursing interventions in improving the ability of families of children with T1DM in handling diabetes-specific family conflict and efforts to prevent depression in children so that children can have better quality of life.

Factors associated with disordered eating behaviours in adolescents with Type 1 diabetes.

To assess the occurrence of disordered eating behaviours in teenagers with Type 1 diabetes and to compare characteristics according to level of disordered eating behaviours. In this cross-sectional study, we collected adolescents' demographic and diabetes management data by parent-youth interview and chart review. Teenagers completed psychosocial surveys, including the Diabetes Eating Problem Survey-Revised (DEPS-R), a diabetes-specific measure of disordered eating behaviours. We categorized teenagers according to level of disordered eating behaviours: low, DEPS-R score <10; moderate, DEPS-R score 10-19; and high, DEPS-R score ≥20. The 178 teenagers (48% girls) were aged 14.9±1.3 years, with diabetes duration of 7.4±3.7 years. Most (59%) had low, 26% had moderate, and 15% had high levels of disordered eating behaviours. Several biomedical and psychosocial characteristics differed by level of disordered eating behaviours. There were more girls in the moderate (62%) and high (65%) than in the low level of disordered eating behaviours group (37%; P=0.003) and more obese teenagers in the moderate (13%) and high (27%) groups than in the low group (4%; P=0.0003). Frequency of daily blood glucose monitoring decreased (P=0.0006) and HbA1c level increased (P=0.01) with greater level of disordered eating behaviours. A greater level of disordered eating behaviours was also associated with poorer treatment adherence, more negative affect regarding blood glucose monitoring, poorer quality of life, and more depressive symptoms (all P<0.0001), along with more diabetes-specific family conflict (P=0.01). Identifying teenagers with Type 1 diabetes who have moderate and high levels of disordered eating behaviours may prevent progression to eating disorders and substantial morbidity by directing support and intervention efforts to those in need.

Establishing a Clinically Meaningful Cut-Point for the PAID-PR (Problem Areas in Diabetes-Parent Revised) Survey

Managing type 1 diabetes (T1D) in youth can create substantial family distress and affect diabetes care efforts. The current study aimed to establish a cut-point on the PAID-PR, a previously validated measure of diabetes distress in parents of youth with T1D. The 18-item PAID-PR has shown construct validity with BGM frequency, A1c, and measures of diabetes-specific family conflict (DSFC) and general quality of life (QoL). Higher PAID-PR scores (range 0-100) indicate more diabetes distress. We applied a standard approach to identify a meaningful cut-point: scores ≥75th percentile of the distribution of PAID-PR scores obtained from 2 large clinic samples. Cutoff score was confirmed by convergent validity, including demographics, diabetes data from youth, and parent reported psychosocial measures (DSFC and QoL). The sample included 527 parents of youth with T1D. Youth (50% male, 84% white) were aged (M±SD) 14.0±2.5 years with T1D duration 6.3±3.6 years; 86% were from 2-parent families. Youth checked BG 5.3±2.5 x/day; A1c was 8.4±1.1% and 69% were pump-treated. PAID-PR score was 43.3±18.5 (range 0-92, IQR 31-56). Analyses determined a cut-point of 56. Youth whose parents scored in the upper quartile vs. lower 3 quartiles were similar with respect to sex and racial distributions, age, percent 2-parent families, T1D duration, and BG checks/day. There were significant differences in A1c (8.6±1.2 vs. 8.3±1.1%) and pump use (60 vs. 71%) (p&amp;lt;.01 for both) between youth whose parents were in the upper vs. lower 3 quartiles of the PAID-PR. Parents in the upper quartile vs. lower 3 quartiles reported more DSFC and poorer youth QoL (p&amp;lt;.001 for both). As youth-onset T1D may engender diabetes distress in families, pediatric diabetes teams recognize the need to identify parents experiencing extreme symptoms. A cut-point of 56 on the PAID-PR appears to identify families in need of additional medical and psychological support in order to improve biomedical and psychosocial outcomes. Disclosure L.J. Tinsley: None. P.V. Commissariat: None. L. Volkening: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. M. Katz: None. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson &amp; Johnson Diabetes Institute, LLC..

Establishing a Clinical Cut-Point for the PAID-Peds (Problem Areas in Diabetes-Pediatric) Survey

Limited access to pediatric diabetes mental health care suggests a need to readily identify youth requiring referral. The current study aimed to establish a clinically meaningful cut-point on the PAID-Peds, a previously validated measure of diabetes distress in youth with type 1 diabetes (T1D). The 20-item PAID-Peds has shown construct validity with measures of depressive symptoms, diabetes-specific family conflict (DSFC), and general quality of life (QoL). Higher scores (range 0-100) indicate more distress. ROC analyses in youth 8-17 years old compared PAID-Peds scores against established clinical cutoffs for depressive symptoms on the Center for Epidemiological Studies - Depression Scale (CES-D) and Depression Scale for Children (CES-DC) to identify a meaningful clinical cutoff for the PAID-Peds. Confirmation of the cutoff score included assessment of convergent validity with glycemic control and teen-reported measures of treatment adherence, diabetes specific family conflict, and QoL. The sample included 427 youth ((M±SD) age 14.3±2.1 years, T1D duration 6.4±3.7 years, and A1c 8.4±1.1%); 49% were male, 83% white, 83% from 2-parent families, and 69% pump-treated. ROC analyses identified a cut-point of 41, with sensitivity of 79%, specificity of 69%, and negative predictive value (NPV) of 94%. Youth with PAID-Peds scores ≥41 (n=168) vs. &amp;lt;41 were more likely to be female (59 vs. 45%), perform less frequent BG monitoring (4.8 vs. 5.5x/day), and have higher A1c (8.6 vs. 8.2%) (p &amp;lt;.01 for all). Youth endorsing more distress (≥41 vs. &amp;lt;41) also reported lower adherence and QoL, and more DSFC (p &amp;lt;.001 for all). The cutoff score of 41 on the PAID-Peds has acceptable sensitivity, specificity, and NPV, and warrants future assessment in clinical research and practice. Establishing a cut-point for clinically meaningful diabetes distress may help clinicians to identify youth at risk for poorer biomedical and psychosocial outcomes, thereby prompting timelier referral for mental health support. Disclosure P.V. Commissariat: None. L.J. Tinsley: None. L. Volkening: None. D.A. Butler: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson &amp; Johnson Diabetes Institute, LLC..

Associations of Executive Function (EF) with Diabetes Management and Glycemic Control in Teens with Type 1 Diabetes (T1D)

Background: Management of T1D requires processes of EF such as planning, problem-solving, and task-completion. This study examined associations of EF with T1D management and outcomes in teens with T1D. Methods: Teens and their parents completed self-report and parent proxy-report versions, respectively, of the Behavior Rating Inventory of Executive Function (BRIEF). Scores ≥60, as total (Global Executive Composite [GEC]) score or on 2 indices (Behavioral Regulation [BRI] and Metacognition [MI]) indicate EF problems. Parents completed validated surveys assessing teen adherence, teen T1D self-efficacy, parent involvement in T1D care, and diabetes-specific family conflict. Results: The sample (N=169, 54% male) was 15.9±1.3 (M±SD) years old and had T1D for 8.4±3.7 years; 67% were pump treated, A1c was 8.5±1.2%. Parent reported vs. teen reported GEC scores uncovered 25% vs. 9% of teens with EF problems (p&amp;lt;.001). Teens with EF problems (GEC, BRI, MI) by parent proxy-report were less likely to use pump therapy and had higher A1c, poorer adherence, lower T1D self-efficacy, more parent involvement, and greater family conflict (Table). Conclusions: Parents appear to be more likely than teens to identify teen EF problems. Screening for executive dysfunction in teens with T1D should be considered in order to identify teens in need of family and healthcare team support. Disclosure M. Hansmann: None. Z. Guo: None. L. Volkening: None. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson &amp; Johnson Diabetes Institute, LLC..