title: Are family factors universally related to metabolic outcomes in adolescents with Type 1 diabetes?
abstract: OBJECTIVE
  To assess the importance of family factors in determining metabolic outcomes in adolescents with Type 1 diabetes in 19 countries.
  
  
  METHODS
  Adolescents with Type 1 diabetes aged 11-18 years, from 21 paediatric diabetes care centres, in 19 countries, and their parents were invited to participate. Questionnaires were administered recording demographic data, details of insulin regimens, severe hypoglycaemic events and number of episodes of diabetic ketoacidosis. Adolescents completed the parental involvement scale from the Diabetes Quality of Life for Youth--Short Form (DQOLY-SF) and the Diabetes Family Responsibility Questionnaire (DFRQ). Parents completed the DFRQ and a Parental Burden of Diabetes score. Glycated haemoglobin (HbA(1c)) was analysed centrally on capillary blood.
  
  
  RESULTS
  A total of 2062 adolescents completed a questionnaire, with 2036 providing a blood sample; 1994 parents also completed a questionnaire. Family demographic factors that were associated with metabolic outcomes included: parents living together (t = 4.1; P < 0.001), paternal employment status (F = 7.2; d.f. = 3; P < 0.001), parents perceived to be over-involved in diabetes care (r = 0.11; P < 0.001) and adolescent-parent disagreement on responsibility for diabetes care practices (F = 8.46; d.f. = 2; P < 0.001). Although these factors differed between centres, they did not account for centre differences in metabolic outcomes, but were stronger predictors of metabolic control than age, gender or insulin treatment regimen.
  
  
  CONCLUSIONS
  Family factors, particularly dynamic and communication factors such as parental over-involvement and adolescent-parent concordance on responsibility for diabetes care appear be important determinants of metabolic outcomes in adolescents with diabetes. However, family dynamic factors do not account for the substantial differences in metabolic outcomes between centres.
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Vic., Australia. fergus.cameron@rch.org.au
authors.forename: F J
authors.initials: FJ
authors.lastname: Cameron
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
authors.forename: C E
authors.initials: CE
authors.lastname: de Beaufort
authors.forename: H
authors.initials: H
authors.lastname: Hoey
authors.forename: P G F
authors.initials: PG
authors.lastname: Swift
authors.forename: H
authors.initials: H
authors.lastname: Aanstoot
authors.forename: J
authors.initials: J
authors.lastname: Aman
authors.forename: P
authors.initials: P
authors.lastname: Martul
authors.forename: F
authors.initials: F
authors.lastname: Chiarelli
authors.forename: D
authors.initials: D
authors.lastname: Daneman
authors.forename: T
authors.initials: T
authors.lastname: Danne
authors.forename: H
authors.initials: H
authors.lastname: Dorchy
authors.forename: E A
authors.initials: EA
authors.lastname: Kaprio
authors.forename: F
authors.initials: F
authors.lastname: Kaufman
authors.forename: M
authors.initials: M
authors.lastname: Kocova
authors.forename: H B
authors.initials: HB
authors.lastname: Mortensen
authors.forename: P R
authors.initials: PR
authors.lastname: Njølstad
authors.forename: M
authors.initials: M
authors.lastname: Phillip
authors.forename: K J
authors.initials: KJ
authors.lastname: Robertson
authors.forename: E J
authors.initials: EJ
authors.lastname: Schoenle
authors.forename: T
authors.initials: T
authors.lastname: Urakami
authors.forename: M
authors.initials: M
authors.lastname: Vanelli
authors.forename: R W
authors.initials: RW
authors.lastname: Ackermann
authors.forename: S E
authors.initials: SE
authors.lastname: Skovlund
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000523:psychology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010342:Patient Acceptance of Health Care; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose