Laura B. Williams

Glycemic Control in Youth with Type 1 Diabetes: Family Predictors and Mediators

OBJECTIVE This study examined predictive and mediated relationships among youth perception of critical parenting, Child Behavior Checklist Externalizing Subscale (CBCL) externalizing problem scores, adherence, and (hemoglobin A(1c) HbA(1c)), in youth with type 1 diabetes from low socioeconomic status families. METHODS Caregiver/youth dyads (n = 120) completed diabetes specific measures of family functioning regarding diabetes management and structured adherence interviews. Parents completed the CBCL, while assays of youth HbA(1c) were performed. Analyses were conducted using hierarchical linear regression. RESULTS Combined measures predicted 44% of the variance in HbA(1c). Adherence partially mediated critical parenting and HbA(1c), while critical parenting and adherence mediated CBCL externalizing problem scores and HbA(1c). CBCL externalizing problem scores did not mediate critical parenting and HbA1(c). CONCLUSIONS The presence of youth perceptions of critical parenting and youth externalizing behavior problems may interfere with adherence, leading to increases in HbA(1c).

Validity and Reliability of an Adolescent and Parent Rating Scale of Type 1 Diabetes Adherence Behaviors: The Self-Care Inventory (SCI)

OBJECTIVE Accurate assessment of diabetes regimen adherence behaviors in youth is a challenging endeavor and is limited by a paucity of empirically supported measures. The purpose of this research is to further demonstrate the validity and reliability of the Self-Care Inventory (SCI), a youth and parent report measure of adherence with diabetes self-care behaviors. The SCI was chosen given its ease of implementation, applicability to multiple diabetes regimens, and dual parent/youth formats. METHODS Participants were 164 youth with type 1 diabetes and a parent. Measures were administered at regular office visits to a tertiary care diabetes clinic. RESULTS The SCI has strong psychometric properties, including adequate internal consistency, parent-youth agreement, and test-retest agreement. Relations between the SCI and a structured interview of diabetes adherence (the Diabetes Self-Management Profile; DSMP) and hemoglobin A1c (HbA1c) were strong. CONCLUSIONS In addition to demonstrating strong psychometrics, this research provides independent support for the SCI. Thus, the SCI is consistent with recent criteria proposed by Quittner et al. (Journal of Pediatric Psychology, 33, 916-936) for an empirically supported measure of regimen adherence. Although other methods of accessing adherence may provide more comprehensive assessments, the brevity, ease-of-implementation, and robustness for multiple regimens makes the SCI an ideal tool for clinicians and researchers.

Diabetes-specific family conflict and psychological distress in paediatric Type 1 diabetes

Aims  Diabetes‐specific family conflict is associated with suboptimal adherence and glycaemic control. Little is known about the individual and family factors associated with diabetes‐specific family conflict. The purpose of this study was to examine whether background factors (e.g. age, gender), diabetes variables (e.g. duration of diabetes, adherence, glycaemic control) and psychological distress (i.e. depression and anxiety) in parents and children and adolescents were associated with diabetes‐specific family conflict.

Type 1 Diabetes in Youth: The Relationship Between Adherence and Executive Functioning

This pilot study examined the relationship between executive functioning and adherence to diabetes regimen adherence in 130 children with type 1 diabetes. Consistent with our hypothesis, parent report of a childs executive functioning predicts that childs adherence to the diabetes regimen. However, contrary to our prediction, age was not a moderator in this relationship. These results suggest that higher levels of a childs ability to problem solve, self-monitor, and utilize working memory are related to higher rates of adherence regardless of age. These findings emphasize the importance of the assessment of executive functioning for optimal pediatric diabetes care.

Feeding problems reported by parents of young children with type 1 diabetes on insulin pump therapy and their associations with children’s glycemic control

Objective: Previous research demonstrated high rates of perceived mealtime behavior problems in families of young children with type 1 diabetes who were managed with conventional therapy. Because of new insulin regimens that offer greater flexibility, reexamination of mealtime behaviors is required. We assessed parent‐reported mealtime behaviors in a sample of young children using an insulin pump. An additional aim was to evaluate the associations of two measures of parental feeding behavior with children’s glycemic control.

The Diabetes Family Behavior Checklist: A Psychometric Evaluation

The Diabetes Family Behavior Checklist (DFBC) assesses supportive and non-supportive parental behavior specific to diabetes management via parent and child reports. The DFBC was administered to 133 children with type 1 diabetes (T1D) and their caregivers. Subsequent analysis verified the two-factor structure of the DFBC corresponding to positive and negative support behaviors. Internal consistency was high for DFBC scores. Moderate to strong correlations with other measures of diabetes-specific familial behaviors, adherence, and metabolic control support the validity of the DFBC. Clinical application of the DFBC is discussed.

Further Examination of a Structured Adherence Interview of Diabetes for Children, Adolescents, and Parents

This study evaluated the factor structure of the Diabetes Self-Management Profile (DSMP), a structured interview for diabetes regimen adherence for children with type 1 diabetes. Study aims included a detailed examination of parent-child agreement in ratings of adherence. The DSMP was administered to 121 children and their parents during routine visits to a tertiary care diabetes clinic. Confirmatory factor analysis of the rationally derived five subscales yielded poor fit indexes. Subsequent exploratory factor analysis supported a two-factor solution for both the parent and child DSMP adherence ratings with factors named Food and Insulin Schedule Adherence and Adherence to Blood Sugar Testing and Adjustments. The internal consistency of the factors was acceptable, and predictive validity was supported vis-a-vis positive correlations with metabolic control (HbA1c). This factor structure appears to provide a brief yet reliable and valid framework for assessing adherence and predicting metabolic control in children. In addition, parent-child agreement varied as a function of age. However, poor metabolic control did not relate to higher parent-child disagreement.

Observational assessment of family functioning in families with children who have type 1 diabetes mellitus.

Objective: Children with type 1 diabetes mellitus have a complex treatment regimen that includes insulin therapy and dietary requirements (e.g., matching insulin and carbohydrate intake). Previous research has shown that parents of children with type 1 diabetes mellitus report significant mealtime challenges and higher parenting stress compared to parents of healthy controls. The objective of the current study was to compare family functioning in children with type 1 diabetes mellitus (ages 2-8) to a matched, healthy control sample. Sixty-six families (33 diabetes; 33 controls) participated in a home visit at which their evening meal was videotaped. Tapes were then coded using the McMaster Interaction Coding System to objectively assess family functioning. Results: Results indicated that families in the diabetes group demonstrated significantly poorer family functioning in a majority of areas (communication, affect management, family roles, overall functioning) compared to the healthy control sample. Additionally, families with lower socioeconomic status and families of male children evidenced poorer overall family functioning for both groups. Conclusions: Results also suggest that family-focused interventions for young children with type 1 diabetes should include components targeting family functioning in the areas of communication, affect management, and family roles.

Brief Report: Normative Data on a Structured Interview for Diabetes Adherence in Childhood

OBJECTIVE This study provides normative data, divided by age and gender, for the Diabetes Self-Management Profile (DSMP), an empirically supported structured interview that assesses adherence with the type 1 diabetes treatment regimen. Despite wide use, normative data on the DSMP have yet to be reported. METHODS The sample included 444 parents and 275 youth with type 1 diabetes. The DSMP was administered by a trained clinician. RESULTS For both child and parent ratings of adherence, means and standard deviations for the overall sample and subdivision by gender and three age groups are presented for normative comparisons. Subscale data (e.g., glucose monitoring, diet, exercise) are similarly presented. Lower adherence scores were reported among older adolescents relative to preadolescents. CONCLUSIONS The literature has lacked normative data on pediatric diabetes adherence. These data present means and standard deviations for parent and child ratings of regimen adherence from a relatively large sample of youth with diabetes that can be utilized for normative comparisons for clinical and research purposes.

Family Functioning and Adherence in Youth With Type 1 Diabetes: A Latent Growth Model of Glycemic Control

The objective of this research is to determine the direct impact of family variables on initial status of a glycosylated hemoglobin A1c test (HbA1c) and HbA1c rate of change, and to determine the indirect effects of family variables on HbA1c through adherence. Study participants were 224 children and their parents who completed baseline measures of diabetes-specific family functioning and separate parent- and child-structured adherence interviews. HbA1c assays were performed at baseline, Year 1, and Year 2. Latent growth curve modeling indicated that, together, disagreement about responsibility for diabetes regimen, critical parenting, parental guidance, and parental warmth predicted initial status of HbA1c through adherence. Individually, critical parenting indirectly predicted initial status of HbA1c. Family variables did not directly predict initial status or rate of change in HbA1c, and did not indirectly predict rate of change in HbA1c over 2 years. Risk for high HbA1c remains elevated over time for children reporting critical parents, but their trajectory does not indicate compounding risk over time.