Influence of the initial management regimen and family social situation onglycemic control and medical care in children with type I diabetes mellitus

It is well known that social family factors are of importance in diabetes c are, but it is not clear whether the initial management regimen can buffer these factors. In a prospective, randomized intervention study, 36 children with diabetes mellitus (type I) were followed, the aim being to study if a family psychosocial intervention at diagnosis could improve glycemic contr ol and minimize hospital admissions. The control group was treated initiall y in a hospital ward, while the study group received problem-based learning and family-therapeutic and social support in an out-hospital training apar tment. A number of family social variables were evaluated at the time of di agnosis and 6, 12 and 24 mo later. Family function was assessed using the s elf-estimated Family Climate Test at these same time-points. HbAlc values a nd information concerning in- and out-hospital visits to the pediatric clin ic were collected for the 5-y period following diagnosis. We found no assoc iation between the offered management regimen and glycemic control or rate of readmission. In the study group only, both parents reported a significan t improvement of the family climate. An increased risk for poor glycemic co ntrol was recorded in children living in one-parent families (p = 0.03) or in families where the father had a low level of education (p = 0.04). Young er age (p = 0.05), a single-parent family (p = 0.05) and poor glycemic cont rol (p = 0.02) were associated with more days of rehospitalization. The rat e of divorce in the whole group was at least as high as in the normal popul ation but, surprisingly, maternal dysfunction was associated with lower HbA 1c value. The conclusion is that even with an initial management regimen designed to offer a family-individual care regimen based on accurate estimation of the psychological and pedagogical needs, the social family background is a most important factor for the glycemic control and need for readmission.