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Peer, parental relationships influence outcomes for teens, young adults with type 1 diabetes
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Adolescents and emerging adults with type 1 diabetes who report supportive peer and parental relationships are more likely to report less emotional and food- and treatment-related distress 1 year later, according to findings reported in Diabetes Care.
“Despite an increased orientation toward friends, emerging adults with type 1 diabetes report having fewer friends and experience less friend support than their agemates,” Koen Raymaekers, MSc, a doctoral student at the University of Leuven, Belgium, and colleagues wrote in the study background. “Unfortunately, little research has investigated the unique role of peers and parents for well-being and diabetes-specific functioning. Further, although qualitative studies have acknowledged the importance of peers in diabetes management, quantitative studies are inconclusive.”
Raymaekers and colleagues analyzed data from 467 adolescents aged 14 to 17 years, and young adults aged 18 to 25 years, with type 1 diabetes from the Belgian Diabetes Registry who participated in a two-wave, longitudinal study (mean age, 19 years; mean diabetes duration, 7.1 years; 80% using injection therapy). At two timepoints over 2 years, participants completed several questionnaires to assess peer and parental support, including the Inventory of Parent and Peer Attachment (the quality of communication and degree of trust subscales), the Child Report of Parent Behavior Inventory, the Extreme Peer Orientation questionnaire and three subscales of the Problem Areas in Diabetes (PAID) scale. Treatment adherence over 1 month was measured via the Self-Care Inventory. Researchers assessed HbA1c values obtained from treating physicians. Researchers used cross-lagged analysis from a structural equation modeling approach to assess the association between peer and parental support and diabetes management.
Within the cohort, mean HbA1c was 7.7%; 72.5% reported living with their parents, 76.2% were students and 19.7% had a university degree.
Researchers found that peer support at timepoint 1 predicted relative decreases in emotional, food and treatment distress at timepoint 2. Parental responsiveness at timepoint 1 predicted relative decreases in food distress at timepoint 2, whereas extreme peer orientation at timepoint 1 predicted relative increase in treatment distress at timepoint 2.
Researchers also observed that treatment adherence at timepoint 1 predicted relative decreases in extreme peer orientation, treatment distress and HbA1c values at timepoint 2. Sex did not moderate the estimates; however, at least some paths were moderated by age. For example, food distress at timepoint 1 positively predicted HbA1c values at timepoint 2 for adolescents (beta = 0.195; P = .037), but not for young adults. Additionally, extreme peer orientation at timepoint 1 positively predicted HbA1c values at timepoint 2 for young adults (beta = 0.135; P = .02), but not adolescents.
“This was one of the first studies to ask adolescents and emerging adults with type 1 diabetes about their relations with peers at a certain point in time and 1 year later,” Raymaekers told Endocrine Today. “Our study results indicate that peers are important for patients’ diabetes-related well-being. More specifically, we found that more general positive relations with peers at one point in time predicted less diabetes-specific distress 1 year later. Additional attention for peer relations during emerging adulthood seems important, as we found that emerging adults who were very oriented toward peers at baseline had worse glycemic control 1 year later.”
Raymaekers added that the findings underscore the importance of clinicians asking patients about their peer relationships.
“If patients indicate that they experience difficulties with peer relations, this may have an impact on patients’ diabetes-related distress and perhaps even on treatment adherence and glycemic control in the long term,” Raymaekers said. “In addition, some patients may experience their diabetes as a burden when interacting with peers and therefore neglect treatment in favor of fitting in with peers. Therefore, when there are indications of problematic relations with peers, the clinician should think and talk with the patient on how to improve these relations without sacrificing treatment or feeling distressed by their diabetes.”
The researchers noted that the study time interval of 1 year “may have been too long” to capture relevant mechanisms between study variables, as some effects may only operate in the short term.
“For example, extreme peer orientation may affect treatment adherence mainly during school days, and not so much on weekends when parents are around,” the researchers wrote. “Hence, future studies should use more intensive, prospective designs, such as diary or ecological momentary assessment.” – by Regina Schaffer
For more information:
Koen Raymaekers, MSc, can be reached at the University of Leuven, Oude Markt 13, 3000 Leuven, Belgium; email: koen.raymaekers@kuleuven.be.
Disclosures: The authors report no relevant financial disclosures.
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