Pediatric Diabetes 2015: 16: 454461 2014 John Wiley & Sons A/S.

doi: 10.1111/pedi.12177 Published by John Wiley & Sons Ltd.

All rights reserved
Pediatric Diabetes

Original Article

The relation between awareness of personal

resources and metabolic control in children
and adolescents with type 1 diabetes

Blicke M, Korner U, Nixon P, Salgin B, Meissner T, Pollok B. The relation Maren Blickea , Ulrike
a
between awareness of personal resources and metabolic control in children
Korner , Patricia Nixona ,
and adolescents with type 1 diabetes. Burak Salginb , Thomas
Pediatric Diabetes 2015: 16: 454461. Meissnerb and Bettina
Introduction: The study aims to elucidate whether awareness of personal Polloka
resources, such as positive attributions and beliefs or social support, affects a Institute
of Clinical Neuroscience and
metabolic control in children and adolescents with type 1 diabetes. In Medical Psychology, Medical Faculty,
addition, it will be determined to what extent metabolic control is influenced Heinrich-Heine-University, Duesseldorf,
by concordance between children and parents regarding awareness of Germany; and b Department of General
resources and the parents ability to adopt their childrens perspective. Also, Pediatrics, Neonatology and Pediatric
the childrens wishes particularly in relation to their illness will be investigated, Cardiology, University Childrens
Hospital, Heinrich-Heine-University,
as well as the kind of advice they would offer to fellow patients.
Duesseldorf, Germany
Methods: Seventy-eight children/adolescents with type 1 diabetes completed
the Essen Resource Inventory for Children and Adolescents including personal, Key words: metabolic control
social, structural, and migration-specific resources. In addition, resource awareness type 1
children/adolescents and their parents completed a systemic-oriented, diabetes
diabetes-specific resource questionnaire in order to explore the parents ability
Corresponding author:
to adopt their childrens perspective. Dr Maren Blicke, PhD,
Results: Resources such as body awareness and open-minded attitude to the Institute of Clinical Neuroscience and
disease were associated with metabolic control. Particularly, resources Medical Psychology,
associated to a migration background were found to be inversely correlated Medical Faculty,
with hemoglobin A1c (HbA1c) value. Moreover, it was shown that the Heinrich-Heine-University,
parents ability to adopt their childrens perspective was associated with Universitaetsstr. 1,
improved metabolic control. Children advising fellow patients to accept the 40225 Duesseldorf,
disease showed the best HbA1c value. Germany.
Discussion: This data identified specific modifiable factors related to Tel: +49-211-81-13319;
fax: +49-211-81-13015;
metabolic control that can be addressed during counseling of pediatric
e-mail:
patients. Also the parents ability for adopting their childs perspective was maren.blicke@uni-duesseldorf.de
identified as a relevant factor which should be considered during clinical
counseling of young type 1 diabetes patients. Submitted 18 January 2014.
Accepted for publication 11 June
2014

Several studies have investigated that factors affecting
metabolic control in children and adolescents suffering
from type 1 diabetes mainly focus on demographic
factors. These data suggest that the patients age (14),
gender (2, 57), illness duration (3, 8), socioeconomic
status (2, 8, 9), as well as the parental family
status (10) have an impact on metabolic control.
Particularly, children and adolescents with a migration
background (including ethnic minorities) show worse
454
blood sugar levels than children and adolescents
without a migration background (8, 1114). Although
being helpful in identifying adolescents at risk, these
factors are not easily influenceable. Hence, they cannot
contribute to the improvement of metabolic control
thereby reducing or even avoiding long-term effects
due to enhanced blood sugar levels. Therefore, the
question arises which potentially manipulable factors
might be conducive to health in young diabetes

patients. These factors exerting a protective influence
against critical life situations such as stress or illness
are subsumed as personal resources, such as positive
attributions and beliefs or social support. Petermann
and Schmidt (15) define resources as potentials
promoting development which are currently available.
In counseling and psychotherapy, resources are
internal potentials of a person regarding capabilities,
skills, knowledge, perspectives, and experience. An
intervention that focuses on the development of
competence by activating personal resources represents
a resource-oriented intervention. Resource variables
are associated with health status in a positively linear
way (16). It is assumed that people in distress are unable
to perceive personal resources. Therefore a broadening
of perspective might contribute to problem solving.
Systemic- and solution-focused counseling is one
possible psychological resource-oriented intervention
method aiming at activating personal resources that
the individual is not aware of. This method takes into
account salutogenetic aspects rather than pathogenetic
ones. Personal resources are activated by using certain
systemic question techniques, e.g., exception (Did
you remember to test your blood glucose level and
give insulin at school? Did this make a difference to
your levels later in the day? Which personal resources
could be invoked to ensure you remember on other
days?). This study aims at identifying resources having
a positive effect on treatment outcome and long-
term metabolic control in children and adolescents
suffering from type 1 diabetes. It has been shown
that self-care is one of the positive attributes which
contributes to personal resources (1719). Self-care
is a comprehensive measure of medical compliance
such as regular blood glucose testing and observance
of other diabetes-associated behavior rules. Low self-
care in adolescents exerts a negative influence on the
hemoglobin A1c (HbA1c) value (2, 20, 21). Besides
personal factors, metabolic control is influenced by
social relationships, too. In particular, satisfying family
relationships or family support can have a positive
influence on long-term metabolic control (2, 18, 22).
It has been shown that an early transfer of parental
responsibility to the child is associated with worse
HbA1c values (23). In a study investigating recently
diagnosed children, Auslander et al. (24) showed that a
lack of family resources from the paternal perspective
was associated with considerably worse metabolic
adjustment. Interestingly enough, resources like family
stress displayed a stronger connection to metabolic
control than established laboratory parameters, such
as C-peptide level as a marker of residual beta-cell
function (24).
Until now, only a few studies exist investigating the
concordance between parental and filial perspectives,
but to the best of our knowledge, no study has yet
Pediatric Diabetes 2015: 16: 454461
Resource awareness in type 1 diabetes
taken into account the parental perspective taking.
In general, in family counseling detecting different
perspectives represents an efficient intervention. This
study aims at elucidating to what extent the parental
ability to adopt the childs perspective regarding such
awareness may influence metabolic control.
Owing to the small numbers of studies investigating
the relation between resources and diabetes, the
questions are addressed whether the perception of
resources is related to metabolic control and whether
specific resources are related to HbA1c in an
explorative way. Therefore, this study aims at (i)
examining whether awareness of resources is related
to metabolic control, (ii) characterizing such resources,
and (iii) addressing the question whether the ability
for perspective-taking by the parents may influence
metabolic control.
Methods
Subjects
A total of 87 subjects were approached for the
study. Eight patients refused participation due to
lack of time or concerns for privacy. One subject
was excluded from data analysis because less than
50% of the items were answered. The remaining
78 subjects (41 males) were aged between 11 and
17 yr (13.88 0.20; mean standard error of mean).
Mean illness duration was 71.46 5.27 months, mean
HbA1c value was 8.06 0.11% corresponding to
64.53 1.17 mmol/mol Hb, and mean body mass
index (BMI) was 21.53 0.38. Seventeen children
(i.e., 21.8%) had a migration background and 25
children (i.e., 32.1%) had an insulin pump. The
patients were recruited from the Department of
General Pediatrics of the University Childrens
Hospital Duesseldorf, Germany. Recruitment took
place during routine outpatient diabetes check-ups
between September 2012 and March 2013. Parents
and children gave their written informed consent
before participation. Study procedures were approved
by the local ethics committee of the Heinrich-Heine-
University, Duesseldorf, Germany. The study was in
accordance with the standards set by the latest revision
of the Declaration of Helsinki.
Procedure
Participants completed the Essen Resource Inventory
for Children and Adolescents (Essener Ressourcenin-
ventar fur Kinder und Jugendliche = ERI-KJ) as well
as a systemic-oriented, diabetes-specific resource ques-
tionnaire (DiabQuest) developed for this study. Parents
were asked to complete the DiabQuest designed for
parents. Both questionnaires took about 20 min to
455
Blicke et al.

Table 1. ERI-KJ dimensions, subscales, and exemplary items

Dimension
Personal resources
Social resources
Structural resources
Additional for children and
adolescents with a migration
background
Subscale
Self-perception and body awareness
Openness and exploration
Autonomy, independence and identity
Self-efficacy
Access to emotions and needs
Social relationships and attachments
Environment: school, training, and
educational establishment
Migration-specific resources
Exemplary items
I feel well in my body.
I feel content with my body.
I would like to learn from my mistakes.
I like giving new activities a try (e.g. sports,
free-time activities)
I like being independent.
I like to complete my tasks on my own.
I feel up to the challenges in life.
I can assert myself (e.g. give my opinion,
insist on my rights).
I know my own feelings and wishes.
I can cope with disappointments.
I can rely on my friends.
I know enough people to help me in difficult
situations.
I have enough liberties to learn and give
new things a try.
I like communicating in social networks
(e.g., Facebook, MySpace).
I know how to communicate well in
German.
I have advantages by my language
diversity.

complete. Parents and children filled out questionnaires
separately in order to ensure independence.
Measures
Questionnaires. Resource awareness was assessed by
the ERI-KJ including personal, social, and structural
resources. The inventory consists of 50 items and has
been validated for children/adolescents aged between
12 and 17 yr (25). It encompasses the subscales self-
perception and body awareness (8 items due to
the special relevance of body awareness in diabetes
these subscales were analyzed separately), openness
and exploration (3 items), autonomy, independence,
and identity (5 items), self-efficacy (4 items), access
to emotions and needs (5 items), social relationships
and attachments (11 items) and environment: school,
training and educational establishment (4 items).
Regarding children and adolescents with a migration
background additional migration-specific resources
such as language skills and cultural and religious
resources are included (10 items). The inventory
is scored using a 4-point Likert scale (0 = never,
1 = seldom, 2 = frequently, and 3 = always). An
overview of subscales including exemplary items is
given in Table 1. The validation phase of the ERI-KJ
is not finished, however, it was used because to the best
of our knowledge there are no comparable measures
which allow the assessment of personal resources by
means of one test.
Aspects relevant to diabetes as well as the
childrens/adolescents needs and wishes were assessed
456
by the DiabQuest which was developed by a team of
experts consisting of pediatricians, diabetes counselors,
and psychologists. Twelve items assumed to play a
major role in coping with diabetes were included (e.g.,
I can accept that others are healthy while I am suffering
from diabetes, I feel controlled by my mother/father
regarding diet and medication intake, I talk openly
about my disease to . . . ). The parent is required to
answer the same items from the childs perspective
in order to assess to what extent the parent is able to
adopt her/his childs perspective (e.g., My child accepts
that others are healthy while she/he is suffering from
diabetes, My child feels controlled by me regarding
diet and medication intake, My child talks openly
about her/his disease to . . . ). Concordance between
parents and children was assessed by measuring
differences between the respective scores. High
differences represent low concordance. In keeping with
the ERI-KJ the questionnaire is scored using a 4-point
Likert scale. In addition, four free text questions are
posed in order to examine further aspects of potential
relevance from the childrens perspective (e.g., I would
give the following advice to other children suffering
from diabetes, I wish my parents would act differently
with respect to my disease in the following way, If
I had a wish, I would wish for . . . ). The answers
to the question I would give the following advice to
other children suffering from diabetes were assigned to
three categories: (i) Acceptance children who give the
advice to accept the illness and continue living normally
as before, (ii) Control children who give the advice to
Pediatric Diabetes 2015: 16: 454461

Table 2. Association between awareness of resources and HbA1c
Correlated variables
Children
Factor Body awareness (ERI-KJ)
Factor Migration-related resources (ERI-KJ)
Item Life is good(DiabQuest)
Item I talk openly to my friends about my illness(DiabQuest)
Parents
Item My childs friends sympathize with her/his illness(DiabQuest)
Item My child talks openly to acquaintances about her/his illness(DiabQuest)
Item My child talks openly to friends about her/his illness(DiabQuest)
*Two-tailed p-values.
control diabetes well and abide by the rules correctly,
and (iii) Miscellaneous the last category consisted of
advice given occasionally. Answers to the question I
wish my parents would act differently with respect
to my disease in the following way were assigned
to the categories (i) no wishes, (ii) less control, and
(iii) miscellaneous. The answers regarding the question
What I would wish for, if I had a free wish were
assorted into (i) diabetes-related and (ii) non-diabetes-
related wishes. Again, parents were asked to answer
these questions from their childrens perspective.
In order to check whether the answers to these free
text questions concur between parents and children,
three categories were formed in the following way:
0 = no congruence, i.e., parental and filial answers
did not concur at all, 1 = medium congruence, when
children and parents showed thematic congruence, and
2 = complete congruence, if children and parents made
exactly the same statement.
Glycemic control. HbA1c was measured during
routine check-ups (immunoturbidimetric technique,
IFCC calibrated, Roche Diagnostics, Mannheim,
Germany) on the same day the questionnaires were
completed.
Statistics
Data analysis was conducted using ibm spss statistics
20. Correlations between resource awareness as
revealed by ERI-KJ and DiabQuest and HbA1c as
well as HbA1c and concordance between children
and parents were calculated using Spearmans
correlation analysis. In a next step, correlations
between items correlating significantly with HbA1c
were calculated. Categories resulting from the analysis
of the free text answers were compared regarding
HbA1c using KruskalWallis test, or MannWhitney
U test, respectively, depending on the number of
categories formed. Post hoc analysis was performed
by MannWhitney U test.
Pediatric Diabetes 2015: 16: 454461
Resource awareness in type 1 diabetes
HbA1cr p*
0.28 0.016
0.55 0.022
0.27 0.019
0.27 0.016
0.26 0.024
0.29 0.013
0.27 0.021
Results
Resource awareness and its relation to HbA1c
With respect to resources, two factors measured by
means of the ERI-KJ were significantly correlated with
the HbA1c value: body awareness and resources related
to migration (Table 2).
Regarding DiabQuest significant correlations
between resources perceived by the parents and
HbA1c were found: My childs friends sympathize
with her/his illness, My child talks openly to
acquaintances about her/his illness, My child talks
openly to friends about her/his illness. Regarding
the children, the item life is good, as well as
the item I talk openly to my friends about my
illness correlated significantly with the HbA1c value
(Table 2).
Correlations between items
Concerning the children, the item life is good
correlated significantly with body awareness (r = 0.43,
p = 0.000).
All the parents answers in the DiabQuest
which correlated significantly with HbA1c (Table 2)
correlated with each other in a highly significant
way (r = 0.43, p = 0.000; r = 0.35, p = 0.002; r = 0.73,
p = 0.000).
Concordances between child and parent and the
relation to HbA1c
A significant correlation between HbA1c and children
and parents regarding resource evaluation as revealed
by the DiabQuest was found particularly regarding
the following items: My friends sympathize with
my illness/My childs friends sympathize with her/his
illness, Diabetes plays a major role in my life/Diabetes
plays a major role in my childs life, My everyday
life is dominated by the illness/My childs everyday
life is dominated by the illness (Table 3). These data
suggest that lower concordance, reflected in more
457
Blicke et al.

Table 3. Difference in resource awareness between child

and parents (Differences of the items DiabQuest C
DiabQuest P) in relation to HbA1c
HbA1c p*
Friends sympathize with the illness r: 0.27 0.022
Diabetes plays a major role r: 0.27 0.022
Everyday life is dominated by the illness r: 0.32 0.005
*Two-tailed p-values.
DiabQuest C = Diabetes-specific questionnaire for children.
DiabQuest P = Diabetes-specific questionnaire for parents.

pronounced differences between children and parents,

is associated with less sufficient metabolic control, i.e.,
higher HbA1c values.
Regarding the correlation between parents and
children in the free text questions, only the item Which
advice would you offer other parents of child patients?
revealed a significant result (r = 0.31, p = 0.044)
suggesting that with increasing congruence the HbA1c
decreases.
Relation between advice to other children suffering
from diabetes and HbA1c
About one third of the children indicated that they
would advice other children to accept the disease
and continue living normally as before (acceptance),
whereas a further third of the children indicated that
they would advise other children to control diabetes
well and to take the diabetes seriously and abide
by the rules correctly (control). The last category
consisted of wishes that were mentioned occasionally
(miscellaneous). As shown in Fig. 1, children advising
others to accept the disease showed the best mean
HbA1c value. Statistical analysis revealed significant
differences between these groups (2 = 9.10, p = 0.011).
The group difference between acceptance and control
has an effect size of 0.97, between acceptance
and miscellaneous 1.17 and between control and
miscellaneous 0.29.
Relation between needs/wishes and HbA1c
The answers to the question What I would wish for,
if I had a free wish were assorted into diabetes-related
and non-diabetes-related wishes. Fifty-two children
expressed diabetes-related wishes like I would like
to recover, 15 children expressed non-diabetes-related
wishes in a large variety and 11 children did not answer
at all. HbA1c values did not differ significantly between
groups (U = 378, p = 0.857).
The question What would I wish for from my
parents with respect to my disease revealed that
for both parents and children autonomy plays an
important role. Out of 56 statements, 21 children
458
Fig. 1. HbA1c values depending on the kind of advice child patients
would offer (acceptance, control, and miscellaneous). Error bars
indicate standard error of mean. Asterisks denote significant p-values
** < 0.01; * < 0.05.
wished for less control, whereas 22 were content
with their parents. Thirteen statements were assigned
to the category miscellaneous. Children, who were
content with their parents, had an HbA1c value
of 7.75 on average 0.12% (61.14 1.32 mmol/mol
Hb). Children, who wished for less control, had
an HbA1c value of 8.24 on average 0.25%
(66.48 2.68 mmol/mol Hb). Children assigned to
the last category had an HbA1c value of 8.25 on
average 0.22% (66.85 2.40 mmol/mol Hb). This
difference was not found to be significant (2 = 4.09;
p = 0.129, two-tailed testing). Analysis of the parents
free text statements showed that 23 thought, that their
children wished for less control, 9 thought, that their
children were content with them, and 21 were assigned
to the category miscellaneous (25 did not give an
answer).
BMI and the relation to HbA1c
The analysis of the total sample revealed a positive
correlation between BMI and HbA1c (r = 0.25,
p = 0.027). However, in children with HbA1c values
above 9%, an inverse relationship was found suggesting
that children with poor metabolic control displayed a
lower BMI (r = 0.58, p = 0.048).
Discussion
Resources such as body awareness and open exposure
to the disease being significantly associated with
metabolic control have been identified. Particularly,
resources associated to migration background were
found to be inversely correlated with HbA1c.
Moreover, it was shown that the parents ability to
Pediatric Diabetes 2015: 16: 454461

adopt their childrens perspective was associated with
improved metabolic control. Children advising fellow
patients to accept the disease showed the best HbA1c
value.
Resource awareness and its relation to HbA1c
Among the resources determined by the ERI-
KJ especially migration-specific resources and body
awareness were found to be inversely correlated with
metabolic control. Among migration-specific resources
language and cultural aspects prevailed. Children
and adolescents feeling secure with their German
language skills had better blood sugar levels than
those who felt insecure. (Example-items: I know
how to communicate well in German; I have
advantages by my language diversity). Previous studies
investigating children and adolescents with type 1
diabetes suggest that speech-comprehension and lower
level of education of the parents affect the blood
glucose level negatively (14). The present results extend
these findings showing that language skills of children
and adolescents themselves directly affect the blood
glucose level. Potentially, medical personnel may
withhold information from these children or phrase
the information in a too simplistic way possibly
induced by actual or assumed language barriers.
This study shows that migration background is not
necessarily associated with worse blood sugar levels.
Rather, realizing the advantage of ones own migration
background associated with superior language skills
might be helpful for improving metabolic control.
Thus, even in groups presumably at risk, good blood
sugar levels can be achieved when taking these aspects
into account.
The resource body awareness explored how
comfortable a child feels in her/his body and how
satisfied he/she is with the own body. Children, who
felt comfortable, had significantly better HbA1c values.
These findings are supported by the result of a negative
correlation between weight and HbA1c in children
with HbA1c values above 9%. This may indicate that
children with high HbA1c values are restrictive in their
diet and non-compliant regarding diabetes rules to
avoid gaining weight.
It has to be stressed that the validation phase of
the ERI-KJ is not finished yet, i.e., only preliminary
data regarding the reliability of this test are available
by personal communication. Therefore, the data
presented here have to be interpreted with caution.
Regarding the DiabQuest different items correlated
with HbA1c value depending on whether the children
or the parents answered. In children, an open exposure
to the disease in interaction with friends and a
positive life approach are connoted with good long-
term metabolic control. With regard to the parents,
Pediatric Diabetes 2015: 16: 454461
Resource awareness in type 1 diabetes
the positive parental appreciation was correlated with
a better HbA1c value with the following aspects: open
exposure to the disease toward friends as well as the
sympathy of friends regarding the disease. Interestingly
enough, although these aspects refer to the parental
appreciation of the childs social network they were
correlated with the childrens HbA1c, possibly hinting
at a further approach to improving HbA1c.
Concordances between child and parent and the
relation to HbA1c
The analysis of concordance between parents and
children revealed that low concordance, particularly
regarding the questions to what extent friends are
sensitive to the disease and how far diabetes dominates
life, is associated with poor metabolic control. Also,
analysis of the free text questionnaire showed that the
parents ability to adopt their childrens perspectives
attends to better blood glucose control. Thus, the
initial hypothesis that congruency between parents and
children affects blood sugar adjustments, is confirmed
by these data. Particularly, the question regarding
the dominance of the disease showed that marked
differences were associated with a worse HbA1c value.
It is possible, that for children, who accept their disease
and want to live in a normal way, overprotective
parents might mainly focus on the disease itself and its
consequences and continuously point out the negative
perspectives of the disease for their children, which
therefore may lead to conflicts and worse metabolic
control. This interpretation is supported by recent
research (26, 27).
Advice to other children suffering from diabetes,
needs/wishes, and HbA1c
Analysis of the DiabQuest free text question I would
give the following advice to other children suffering
from diabetes suggests that children who recommend
acceptance showed the best HbA1c values. Although
speculative at the moment, this result might reveal a
piece of evidence for the assumption that acceptance
of the disease may be related to the ability to put
ones own life into a positive perspective and to
focus on positive resources without disavowing the
disease itself. Thus, the extent to that positive and
conducive aspects of the self can be focused while
simultaneously being aware of the disease (without
disavowing it), the acceptance toward the own disease
can be fortified. This could explain why children who
gave the advice accept your disease had better HbA1c
values. Concurrently, acceptance would not necessarily
mean, that the wish not to be ill disappears from
ones perception in the end, every child with diabetes
is continuously confronted with the differences of his
459
Blicke et al.
own life and that of healthy peers, who are not ill.
Therefore, the wish not to be ill could coexist next to
the resource acceptance. This could explain, why the
question what would you wish for . . . did not show
a significant correlation to a more sufficient HbA1c
value in children indicating non-diabetes-related
wishes.
Regarding the free text question about what children
would wish for from their parents with respect to
their disease it was shown that for both parents and
children, autonomy plays an important role as both
of them mentioned this aspect most frequently. Those
children, who were content with their parents, had
a better HbA1c value than children, who wished
for less control even though this effect was not
statistically significant. Because a chronic disease is
an early invasion into ones self-determination, the
wish for autonomy is a distinct attribute for affected
children. The children, who expressed a non-diabetes-
related wish, did not have better blood values than
those, who had the wish not to be ill. Therefore, the
acceptance of the disease is not synonymous with the
wish, not to be affected (as discussed above).
All in all, the analysis revealed that several
items being significantly correlated with HbA1c were
correlated with each other. Thus, there is not a subset
of single resources that may be beneficial for metabolic
control. Rather, the data suggest that HbA1c can be
improved by addressing a variety of different resources
possibly yielding the same effect on metabolic control.
Clinical implications
These data suggest that children and adolescents
with type 1 diabetes benefit from the awareness of
the following personal resources: body awareness,
acceptance of the disease, open exposure to the
disease, and migration-related resources. Although
these data are purely explorative, the findings may
be useful for clinical counseling. These resources
should be considered for counseling possibly being
of advantage over pathogenetic-oriented strategy in
relation to the blood-sugar adjustment. One possibility
to cultivate acceptance during daily clinic routine,
could be a long-term training of clinic-personnel in
resource-focusing counseling. All conversation, even
those between doors, even very short contacts with
patients contain a possibility to cultivate acceptance
based on resource and solution-focused counseling,
by helping the patients to focus and to be aware of
their resources and by trying to support a change
of perspective toward positive aspects of their lives.
Therefore, acceptance could be the result of a strategy,
which holds the patients in esteem and supports their
progress to deal with the disease by using resource and
solution-oriented counseling.
460
In particular, consideration of migration-specific
resources is expected to offer adequate help for
these groups at risk. Therefore, emphasis should be
laid on overcoming language barriers and imparting
knowledge about the disease and its treatment. In
line with these data, it was shown, that interventions
for patients with migration-background, including the
parents, can have a positive effect on the blood glucose
control (28).
As the skill for adopting someone elses perspective
contributes to good blood sugar levels, systemic
question techniques (e.g., what would your mother
answer on the question who cares the most/the less for
your metabolic control?) could be advantageous, as
they give information about different perspectives.
All in all, this study identified resources correlated
with metabolic control which should be considered in
clinical counseling.
Acknowledgements
The authors would like to thank Lena Storzer and Johanna
Amrhein of the Institute of Clinical Neuroscience and Medical
Psychology, Medical Faculty, Heinrich-Heine-University for
her help in data entry. BP is grateful for financial support
by grants from the Deutsche Forschungsgemeinschaft (DFG;
PO806-3) and the Medical Faculty of Heinrich-Heine-University
(9772558). TM is supported by the German Federal Ministry
of Education and Research (BMBF; FKZ01GI1109B). Funding
sources had no involvement in the present study.
Conflict of interest
All authors declare that there are no relevant conflicts
of interest to disclose.
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