Are family factors universally related to metabolic outcomes in adolescents with Type 1 diabetes?
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Cameron, FJ and Skinner, TC and de Beaufort, CE and Hoey, H and Swift, PGF and Aanstoot, H and Aman, J and Martul, P and Chiarelli, F and Daneman, D and Danne, T and Dorchy, H and Kaprio, EA and Kaufman, F and Kocova, M and Mortensen, HB and Njolstad, PR and Phillip, M and Robertson, KJ and Schoenle, EJ and Urakami, T and Vanelli, M and Ackermann, RW and Skovlund, SE, Hvidoere Study Group on Childhood Diabetes, Are family factors universally related to metabolic outcomes in adolescents with Type 1 diabetes?, Diabetic Medicine, 25, (4) pp. 463-468 . ISSN 0742-3071 (2008) [Refereed Article]
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Aims: 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 (HbA1c) 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. © 2008 The Authors.
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