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Abstract
Purpose. To determine whether the association between diabetes-specific family conflict and self-monitoring of blood glucose (SMBG) frequency is mediated by diabetes self-efficacy.
Methods. A total of 276 adolescents with type 1 diabetes (aged 15.6 ± 1.4 years; duration of diabetes 6.6 + 1.8 years; A1C 8.9 ± 1.8%) completed measures of diabetes-specific family conflict and self-efficacy. Sociodemographic, family, and disease characteristics (including SMBG frequency and glycemic control) were obtained at the clinic visit.
Results. Multivariate analyses were used to test the mediational role of self-efficacy. The first model established that family conflict was associated with lower levels of self-efficacy. The second model established that increased family conflict was associated with lower SMBG frequency. In the third model, self-efficacy was added, and the effect of family conflict on SMBG frequency became less significant (P = 0.001 to P = 0.03). The indirect effect of family conflict on SMBG frequency through diabetes self-efficacy was significant (Sobel = 2.10, P = 0.035) and explained 22% of the association between family conflict and SMBG frequency.
Conclusions. Results confirm a partial mediational role of diabetes self-efficacy and suggest that a family environment characterized by conflict may also contain poorer self-efficacy in the adolescent. In these cross-sectional analyses, both variables contributed to less frequent SMBG. Future longitudinal research to confirm these relationships and potential avenues for intervention are discussed.
Type 1 diabetes is an autoimmune disease that affects 1 in 500 children and adolescents, and recent estimates show increasing incidence in the United States.1 Treatment of pediatrie type 1 diabetes involves coordinating the timing and administration of insulin with results of self-monitoring of blood glucose (SMBG), dietary intake, and physical activity.2 Effective management of this complex regimen is associated with better glycémie control (i.e., primary indicator of overall diabetes control); however, effective management is hard to achieve for adolescents.3"*
Although a number of individual factors contribute to poor diabetes management in this age-group,7"9 family variables are contributors, as well.10·11 Unfortunately, little is known about the interaction among individual and family variables, particularly in adolescents with type 1 diabetes. The purpose of this study was to further elucidate relationships among these variables.
During adolescence, there is often a shift in responsibility for diabetes management, with the adolescent assuming more responsibility.12'13...