FAMILY ENVIRONMENT, GLYCEMIC CONTROL, AND THE PSYCHOSOCIAL ADAPTATIONOF ADULTS WITH DIABETES

OBJECTIVE - To evaluate whether the family system variables of adults with diabetes relate to the adequacy of metabolic control or the psych osocial adaptation to the illness. RESEARCH DESIGN AND METHODS - A tot al of 150 insulin-requiring adults were assessed on a single occasion. They completed two family system measures (the Family Environment Sca le [FES] and the Diabetes Family Behavior Checklist [DFBC]), two quali ty-of-life measures (the Diabetes Quality of Life Scale and the Medica l Outcomes Study Health Survey-36), and one measure of cognitive appra isal (the Appraisal of Diabetes Scale). Glycemic control was assessed using HbA(1c) results. Demographic data (age, sex, diabetes type, dura tion of diabetes, and number of diabetes-related medical complications ) were gathered from the patients' charts. RESULTS - Concerning glycem ic control, none of the family system measures were significant predic tors of HbA(1c). Older age and longer duration of diabetes predicted h igher HbA(1c) values. For psychosocial adaptation, when family members behaved in ways that supported the diabetes care regimen (measured by the DFBC), the individual with diabetes was more satisfied with his o r her adaptation to the illness and reported less interference in role function due to emotional problems. Family cohesion (measured by the FES) also related to better physical function. Women reported higher l evels of diabetes satisfaction: The Appraisal of Diabetes Scale predic ted glycemic control and psychosocial adaptation. CONCLUSIONS - For in sulin-treated adults with diabetes, family system variables do not rel ate to glycemic control, but they do relate to psychosocial adaptation . Future work should explore the impact of family-centered interventio ns on adaptation, sex differences in adaptation, and the use of the Ap praisal of Diabetes Scale as a first-line clinical screening tool.