Diabetes control and the influence of family functioning

Background: The link between glycaemic control of type 1 diabetes and family functioning is complex, with the existing literature largely focussing upon the association between clear patterns of disturbances in family functioning and suboptimal diabetic control. The more subtle changes to family function that might influence the degree of successful management of a child’s diabetes have been less well studied. Methods: This study sought to explore whether suboptimal glycaemic control was associated with variations in family functioning that might not in themselves prompt concern in routine clinic review. The project focussed on families attending for routine follow-up in specialist paediatric diabetes clinics in the North East of England. Mother and child participants provided demographic information and completed the Family Adaptation and Cohesion Evaluation Scale (FACES IV), and the quality of their glycaemic control was assessed using the mean HbA1c value for each child over the last year. Families with clear emotional or family difficulties, or where the level of control was causing clear concern were excluded (as were families where there was major physical or a member with significant learning disabilities). The sample was divided into two groups; families whose children were in optimal glycaemic control of their diabetes, and families where the glycaemic control was suboptimal. Results: Whatever the degree of control, nearly all the mothers and index children reported functioning within the balanced range. The mothers of children with optimal glycaemic control reported their family to be more cohesive and expressed greater satisfaction with family life than mothers whose child’s glycaemic control was suboptimal. The children with suboptimal diabetic control also tended to view their family life as more chaotic. Discussion: Despite the challenges most families cope reasonably well with the issues that managing type 1 diabetes in a child bring. However suboptimal control tends to be associated with some unhelpful family issues, and the implications for intervention are discussed. Conclusions: Suboptimal control, when it is present, prompts exploration of a wide range of factors. Assessment of family functioning should be part of this process, even if there is no evidence of major family difficulties because subtle distortions in functioning can significantly influence glycaemic control, especially in early adolescence.