The role of marital distress, parental and child depression, family functioning and health care behaviors in treatment adherence and metabolic control among adolescents with diabetes.

Fifty-five adolescents with Type 1 diabetes, who were receiving secondary care services from diabetes clinics and pediatricians, were followed for three months in this exploratory community study. Measures of parental depression, marital distress, general family functioning, and diabetes-specific family functioning were obtained during an assessment of both parents and adolescent. The 24-hour recall adherence interviews were conducted separately with both the parent and adolescent on six occasions over the three months, and metabolic control was measured by HbA1c levels at the onset and end of the study. Multiple regression analyses showed that adherence was not associated with control. Adolescents who had been diagnosed longer were in worse metabolic control. Family relations were not linked with glycemic control and their influence varied on the five dimensions of adherence. The family relations variables, as a model, was significant in predicting diet amount adherence, accounting for 32.8% of the variance, with parental depression and general family conflict accounting for most of it. The family relations model was significant in predicting exercise adherence, with diabetes-specific guidance-control, accounting for 37.2% of the variance. Controlling for chronological age and gender, adolescent depression, as a measure of child adaptation, was not a significant predictor of glycemic control or adherence. However, both gender and chronological age accounted for 39.2% of exercise adherence. Glycemic control was consistent, with 75% of the adolescents displaying stable controlled and non-controlled metabolic control throughout the study. Metabolic control, treatment adherence and frequency of insulin omissions were similar for those receiving treatment from a diabetes clinic versus a pediatrician, Using an insulin sliding scale improved metabolic control, whereas adherence was similar for the groups. Males and females omitted insulin injections equally across the three adolescent age groupings and metabolic control was worse for those who missed insulin injections. Neither adherence nor family relations differentiated between the adolescents who missed or did not miss insulin injections. Parental involvement in the diabetes regime differed by gender, with parents remaining involved with females for longer. Results were discussed in the context of adolescent development and the systems social/ecological model of adaptation and coping developed by Kazak (1989)