How Many Times Do I Need To

Ask You To Test Your Sugar?

A Qualitative Study of Parent-Adolescent
Interactions in Poorly Controlled Diabetes

BD Diabetes Center
Morristown, NJ USA

Gloria Lopez-Henriquez
MSW
Harold Starkman MD
Nicole Pilek MSW

Disclaimer &
Acknowledgments

This project was partially supported by grants from BD

and the HAPI Foundation
We have no conflict of interest to disclose

Background
Family systems theory suggests that families, although
comprised of individuals, form unified and organized
entities that often act and react in concert. Viewed from
this perspective, relational patterns may either facilitate
or impede the capabilities of family members
responsible for an adolescents diabetes management.
Our work seeks to more clearly delineate conflictual
interactions as described by teens with poorly controlled
type 1 diabetes and their parents. Descriptive in nature,
this work is part of a qualitative research effort to
broaden our understanding of the family relational
context of poorly managed diabetes in adolescents.

Subjects

Adolescents age 13 to 18 years with type 1 diabetes

> 1 year duration, and three consecutive routine
HbA1Cs >9.5% over the preceding 6 months were
identified by retrospective HbA1C database review.
This project was reviewed and approved by the Atlantic
Health Institutional Review Board

Methods 1

Initial baseline evaluation included diabetes history,

family health history, ethnicity and socio-economic
status (SES).
A qualitative systemic approach, incorporating circular
interviewing was utilized to capture a more
comprehensive overview of poor diabetes management
within the context of daily family life.

Methods 2

Families participated in a comprehensive, videotaped

semi-structured interview with a family therapist lasting
1 to 2 hours.
Grounded Theory served as our methodological
framework, and data analysis saturation as a measure
of trustworthiness.
All interviews were reviewed by a team of two clinical
social workers and a pediatric endocrinologist.
Transana 2.41 was used for data storage and analysis.
This presentation is limited to an analysis of responses
to interview questions regarding family interactions
around diabetes-related tasks.

Study Population
The cohort (n=27) was comprised of 9 males and 18
females mean age 15 years (SD-1.5).
Mean diabetes duration was 10.3 years (SD-3.8)
Mean HgbA1C was 10.8%(SD-1.6).
Adolescent subjects were: Caucasian (18), AfroAmerican (3), Latino (3), Asian (2) and Biracial (1).
Family incomes were reported as <$50,000 (7), $5075,000 (2), $75,000-$100,000 (5) and >$100,000 (10).
17 subjects had immediate family members with
significant chronic medical disorders.

Identified Themes

Many parents and teens expressed unresolved feelings

of sadness and anger, which began at diabetes
diagnosis and continued to impact diabetes
management.
Struggles in transferring diabetes care responsibilities
from parent to teen were pivotal in organizing families
interactions around diabetes care.
Family conflict was the relational process most readily
described by families. This conflict was often a
byproduct of futile efforts to address the teens poor
diabetes management.

Identified Themes/
Interactional patterns

We observed three distinct patterns of interaction between

adolescents with poor diabetes control and their parents
that we have delineated as dyadic, triadic and
disengagement.

(N=27)

N= 9

N= 14

N= 4

Identified Themes/
Family Interactions
All high risk families interviewed were looking for ways to
better care for diabetes. This goal was difficult to attain
however, since family interactional patterns, initially
developed to address poor management, often became an
entrenched obstacle. This self sustaining process
prevented parents and adolescents from attaining the
glycemic control that they were desperately seeking.

Relational Pattern of Interactions Between Teens with Uncontrolled

Diabetes and Their Parents Related to Diabetes Tasks
Contextual Factors

Conclusions

Poor adolescent type 1 diabetes adherence is

associated with conflict, with patterns and progression
varying by family.
This conflict, often a byproduct of futile and desperate
efforts to increase responsibility and improve metabolic
control, may result in family disengagement from
diabetes care.
Deeper understanding of parent/teen interactions
surrounding sub-optimal diabetes care may provide an
opportunity for more specific and effective intervention.