Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with type 1 diabetes: A prospective study

Objective This prospective study examined how child behavior problems and family functioning predict adherence behavior and glucose regulation (glycemic control) in a sample of economically disadvantaged children. Methods Children with type 1 diabetes (N = 116; 58.6% African American) were assessed for externalizing and internalizing behavior problems and family adaptability and cohesion and followed for a mean of 3.8 years. Glycemic control (glycosylated hemoglobin [HbA(1c)]) was assessed at baseline and follow-up, and adherence was assessed at follow-up. Results Analyses controlled for baseline HbA(1c) and years to follow-up. Multivariate analyses indicated that better adherence was predicted by high family cohesion. Better glycemic control was predicted by high family cohesion, the absence of externalizing behavior problems, and the presence of internalizing behavior problems. In addition, tests of moderation indicated that better follow-up glycemic control occurred among girls from high cohesion families and younger children from low adaptability families. Although better adherence predicted better glycemic control, adherence did not mediate the relationships of behavior problems or family functioning with glycemic control. Conclusions A child's behavior problems and family functioning may influence both adherence to the diabetes regimen and glycemic control several years later, suggesting the potential value of interventions that address child behavior and family functioning.