Improvement of Care & Outcome


Cameron FJ, Skinner TC, de Beaufort CE, Hoey H, Swift PG, Aanstoot H, Aman J, Martul P et al.

Are family factors universally related to metabolic outcomes in adolescents with type 1 diabetes? Diabet Med. 2008;25:463-8.

Certain family factors can significantly affect metabolic outcomes in adolescents with type 1 diabetes, according to the findings of this study.


Diabeter was one of the 21 centers in 19 countries in Europe, Japan, Australia, and North America that took part in the study. A total of 2,062 adolescents aged 11-18 years completed questionnaires about their type 1 diabetes, its management, and parental involvement, with most also providing blood samples for measurement of HbA1c. Questionnaires about familial responsibility for diabetes, and the parental burden of the disease, were completed by 1,994 parents.


Key findings:

  • Adolescents whose parents were separated had a significantly higher HbA1c level than adolescents whose parents were still living together (8.4% versus 8.1%, respectively; P< 0.001).
  • Having a father not in employment was associated with a significantly higher HbA1c level (8.5% versus 8.1% in adolescents with employed fathers; P< 0.001).
  • Overall, 26% of adolescents felt that their parents were too protective, 36% said their parents worried too much, and 22% said parents acted (often or all the time) as if they were the ones with type 1 diabetes.
  • Adolescents whose parents were both in employment reported them being less over-involved in diabetes care, compared with adolescents in families where one or both of the parents were not in employment.
  • The level of parental involvement reported by adolescents was significantly correlated both with HbA1c and with the number of episodes of diabetic ketoacidosis (DKA). The higher the level of involvement, the higher the HbA1c and the more episodes of DKA experienced.
  • The level of parental responsibility for diabetes care, as reported by the adolescents, was not associated with metabolic outcomes. However, greater parental responsibility as reported by the parents was associated with higher HbA1c levels.
  • The greater the level of disagreement between parental and adolescent reports on responsibility for diabetes care, the higher the HbA1c level of the adolescents. This effect was attributable to one item, regardless of the direction of the discordance between parental and adolescent reports: the responsibility for remembering to monitor blood glucose levels.

For PubMed abstract click here.

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