. 2013 Feb;59(2):143–149.

Table 1.

Summary of reviewed studies: All studies measured outcomes using measurement of glycosylated hemoglobin levels.

STUDY	TYPE	PARTICIPANTS	MEASUREMENT TOOLS	MAIN RESULTS
Anderson,¹⁸ 2004	Qualitative review	NA	NA	High levels of diabetes-related family conflict and authoritarian parental style were related to lower levels of treatment adherence and poorer glycemic control Emotional expressiveness within the family and steady parental involvement were related to better glycemic control
Duke et al,¹⁹ 2008	Cross-sectional	120 young people and their caregivers (low income)	DFBS^* DFBC,^† DSMP^‡ (adherence to treatment measurement)	Family behaviour measurement explained 11.8% of the variability in glycemic control, controlling for demographic variables Young people who reported judgmental parental style with regard to diabetes management had higher blood glucose levels
Laffel et al,²⁰ 2003	Cohort	104 children or adolescents and their families	Child quality of life,^§ DFCS^‖	Semistructured interviews of family involvement in T1DM management Clinician-rated adherence scale Family involvement in diabetes treatment can reinforce family conflict, but not when it is included in positive family communication Duration of diabetes did not predict quality of life The parents of children with T1DM reported a slight and statistically important reduction in quality of life compared with the parents of patients without diabetes Family conflict was a prognostic factor for quality of life Child report regarding family conflict was the most important factor in predicting quality of life initially and 1 y later Special family factors, such as family conflict with regard to diabetes, were strongly related to the quality of life of individuals with T1DM
Lewin et al,²¹ 2006	Cohort	109 children (aged 8-18 y) and 1 parent each	DFBS^* DFBC,^† DFRQ^¶	Specific family factors were strongly related to metabolic control Negative family function negatively influenced metabolic control Negative and judgmental relationships with parents were related to worse metabolic control
Viner et al,²² 1996	Cross-sectional	43 children and adolescents and their mothers	FILE^#	Family stress was strongly related to worse glycemic control in children and adolescents The relationship between family stress and diabetes control was bidirectional; poorer diabetes control produced family stress and family stress increased poor control
Jacobson et al,²³ 1994	Cohort	61 children and adolescents (aged 9-16 y) and their mothers	FES^**	Patients coming from less expressive families had greater deterioration of glycemic control during the 4-y cohort study In boys, family cohesion and conflict were related to the glycemic control's deterioration; in girls, low family cohesion and high family conflict were related to worse glycemic control in the initial clinical examination, but did not continue during the follow-up There was no relationship between family organization and glycemic control, as the family's sentimental tone and not its rules and structure influenced metabolic control in adolescent patients with diabetes
Grey et al,²⁴ 2011	Cohort	181 parents and their children	Issues in Coping With IDDM–Parent Scale,^†† CES-D,^‡‡ Diabetes Responsibility and Conflict Scale, Parents DQoL^§§	Improvements in parental coping were associated with decreased parental responsibility for diabetes management and improvement in glycemic control in the short term; premature relinquishment of parental responsibility for diabetes management can lead to deterioration in metabolic control On the other hand, prolonged overmanagement by parents can lead to increased parent-child conflict; helping parents manage this transition through training in coping skills might lead to a smoother transfer of responsibility for diabetes management and, ultimately, to better metabolic control
Williams et al,²⁵ 2009	Cohort	187 children and adolescents	DFCS,^‖ CES-D,^‡‡ STAI,^‖‖ CDI^¶¶	Findings suggested a close link between psychological distress in parents and children or adolescents, and reports of increased diabetes-specific family conflict; in the presence of suboptimal glycemic control, children or adolescents and parents reported more family conflict; adherence was not significantly associated with family conflict
Pereira et al,²⁶ 2008	Cross-sectional	157 children and adolescents (age 10-18 y) and their parents	DFBS,^* FES,^** DQoL^§§	As the duration of diabetes increased, adherence to treatment and metabolic control decreased High family conflict was related to lower quality of life and worse metabolic control Increased family support increased the quality of life for boys and girls; additionally, for the girls, higher family support was related to better adherence to treatment and better glycemic control Quality-of-life factors that directly influenced metabolic control were influenced by different family factors that depended on social class Family conflict was presented as more critical to girls and patients of lower social status; family conflict influenced patients of higher social classes more directly in terms of metabolic control and more indirectly in terms of quality of life Family environment was part of a wider cultural context that strongly influenced metabolic control
Stallwood,²⁷ 2005	Cohort	73 caregivers and children	PAID,^## ADS,^*** CHIP,^††† DSMP^‡	Higher caregiver stress was associated with lower HbA_1c levels; higher levels of home management were associated with lower HbA_1c levels; no significant relationship was noted between caregiver coping and home management

ADS—Appraisal of Diabetes Scale, CDI—Children's Depression Inventory, CES-D—Center for Epidemiologic Studies Depression Scale, CHIP—Coping Health Inventory for Parents, DFBC—Diabetes Family Behaviour Checklist, DFBS—Diabetes Family Behaviour Scale, DFCS—Diabetes Family Conflict Scale, DFRQ—Diabetes Family Responsibility Questionnaire, DQoL—Diabetes Quality of Life scale, DSMP—Diabetes Self-Management Profile, FES—Family Environment Scale, FILE—Family Inventory of Life Events, HbA_1c—glycosylated hemoglobin A_1c, IDDM—insulin-dependent diabetes mellitus, NA—not applicable, PAID—Problem Areas in Diabetes scale, STAI—State-Trait Anxiety Inventory, T1DM—type 1 diabetes mellitus.

Subscales of warmth-care and guidance-control, and perceived family support.

^†

Supportive behaviour related to the diabetic diet.

^‡

Use of structured interview that included 5 areas of diabetes management.

^§

Measuring children's and parents' perceptions about the quality of life of children; 2 subscales of natural and psychosocial function used.

^‖

Section on the management of diabetes.

^¶

Family sharing of responsibilities in diabetes treatment.

Evaluating stressful family factors; was filled out by the main parental figure.

^**

Subscales of cohesion, conflict, and expression, and scale of family organization.

^††

Evaluating mothers' perceptions of coping with the stress of their children's diabetes.

^‡‡

Assessment of mothers' current depressive symptoms.

^§§

Assessment of parents' perceptions of the effects of diabetes.

^‖‖

Measurement of the transient state of arousal subjectively experienced as anxiety; the Trait scale was developed to assess the more enduring characteristic presence of this emotion.

^¶¶

Assessment of depression in children between the ages of 7 and 17 y.

^##

Measurement of changes in psychosocial and emotional states associated with diabetes.

^***

Assessment of the effects of family environment on glycemic control and psychosocial adaptation in adults with diabetes.

^†††

Assessment of parental coping patterns.