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

Abstract

Introduction: We 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 we recruited within the first year of their T1D diagnosis.

Research design and methods: Parents completed the Diabetes Family Conflict Scale-Revised (DFCS-R) to assess for diabetes-related family conflict and the Diabetes Self-Management Questionnaire-Brief (DSMQ-Brief) to assess parent engagement in child T1D care at the initial study visit (T1) and at 12 (T2) and 27 (T3) months later. We also collected child HbA1c at these time points. Our analyses included Pearson correlations and repeated measures linear mixed models controlling for child age, sex, and T1D duration at T1.

Results: Parents' DFCS-R scores negatively correlated with DSMQ-Brief scores (r=-0.13, p<0.05) and positively correlated with children's HbA1c (r=0.26, p<0.001). In our linear mixed models, parents' DSMQ-Brief scores were unchanged at T2 (β=-0.71, 95% CI -1.59 to 0.16) and higher at T3 (β=8.01, 95% CI 6.89 to 9.13) compared with T1, and there was an association between increasing DFCS-R and decreasing DSMQ-Brief scores (β=-0.14, 95% CI -0.21 to -0.06). Child HbA1c values were significantly higher at T2 (β=0.66, 95% CI 0.38 to 0.94) and T3 (β=0.95, 95% CI 0.63 to 1.27) compared with T1, and there was an association between increasing DFCS-R scores and increasing child HbA1c (β=0.04, 95% CI 0.02 to 0.06).

Conclusions: Increasing diabetes-specific family conflict early in T1D may associate with decreasing parent engagement in child T1D care and increasing child HbA1c, suggesting a need to assess and intervene on diabetes-specific family conflict. Trial registration number NCT03698708.

Keywords: children; diabetes mellitus; hemoglobin A1c; self-management; type 1.

Conflict of interest statement

Competing interests: MAC is the chief medical officer for Glooko and has consulted with Medtronic Diabetes and Eli Lilly on topics unrelated to the submitted work. All other authors have nothing to disclose.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Parents’ DSMQ-Brief scores and DFCS-R total scores at initial study visit (T1), at 12 months (T2), and at 27 months (T3). DFCS-R, Diabetes Family Conflict Scale-Revised; DSMQ-Brief, Diabetes Self-Management Questionnaire-Brief.

Figure 2

Children’s HbA1c and parents’ DFCS-R total scores at initial study visit (T1), at 12 months (T2), and at 27 months (T3). DFCS-R, Diabetes Family Conflict Scale-Revised; HbA1c, glycated hemoglobin.