Adolescents With Iddm And Their Families: The Role Of Management Responsibility, Diabetes Knowledge And Skills, And Family Support In Compliance And Metabolic Control

The present study proposed a unique model for evaluating the relationships between responsibility, diabetes problem solving and skills, family factors, compliance, and metabolic control among 50 adolescents with IDDM. The central concepts posited were that: (1) compliance would be directly related to control such that greater compliance would lead to better metabolic control, (2) compliance would serve as a moderator variable between metabolic control and other variables such as responsibility, diabetes problem solving and skills, and family factors, and (3) family factors would also be directly related to metabolic control. In addition, associations among these factors were suggested such that responsibility was expected to be positively related to diabetes problem solving, and negatively associated with diabetes skills and family factors. Adolescents completed The Responsibility Scale Revised, The Test of Diabetes Knowledge Revised-M, The Family Environment Scale, The Compliance Scale, and The Problem Frequency Questionnaire. In addition, glycosylated hemoglobin levels were assessed in order to provide an index of metabolic control. The major findings were first, that better compliance was associated with better metabolic control. Second, relatively better diabetes problem solving was related to better compliance. Third, all the family dimensions of interest were associated with compliance such that adolescents who described their families as more supportive, lower in conflict, more well organized, and who more readily integrated the diabetes regimen into family functioning achieved higher levels of compliance. Fourth, adolescents who described their families as higher in conflict and who perceived them as more disrupted by having diabetes in the family, displayed poorer metabolic control. In addition, family support and organization were related to metabolic control, but this was largely accounted for by their relationship to compliance. Overall, responsibility was not significantly associated with compliance, family factors, diabetes skills, or metabolic control. However, greater responsibility was related to better diabetes problem solving. The findings were discussed in terms of the proposed model, previous research, and clinical implications of the data. In addition, suggestions were made for further refinement of the measures and the proposed model with considerations for future studies in this area