Parent-Child Relationship Quality Mediates the Association of Income with Adherence and Glycemic Control in Youth with Type 1 Diabetes

Background/objective:Among youth with type 1 diabetes, lower family income is consistently associated with poorer diabetes outcomes. Limited previous research suggests that this association may be explained in part by depleted parent psychological resources. The objective of this study was to examine whether the association of income with adherence and glycemic control is mediated by the parent-child relationship quality (i.e. authoritative parenting style, collaborative parent involvement in diabetes management, and diabetes-specific parent-child conflict).

Methods: Youth and their families (n= 390) were participants in a multi-site clinical trial designed to examine the efficacy of a clinic-integrated behavioral intervention targeting family disease management for youth with type 1 diabetes. Baseline data were collected in-person from youth aged 9 to 14.9 years (mean A1c 8.4±1.2, 33.8% pump regimen) and their parents. Parents reported family income and completed a semi-structured interview assessing diabetes management adherence. Both parents and children reported diabetes-specific parent-child conflict. Children completed measures of collaborative parent involvement and authoritative parenting (i.e. responsiveness, demandingness, and psychological control). HbA1c, a biomarker of glycemic control, was analyzed centrally at a reference laboratory.  The relations of income, parenting variables, regimen, adherence, and HbA1c were examined using structural equation modeling in MPlus version 7.  The model specified the following effects: a) income on authoritative parenting, parent-child conflict, and regimen b) authoritative parenting on collaborative parent involvement, c) parent-child conflict and collaborative parent involvement on adherence, and d) adherence and regimen on HbA1c.

Results: Model fit statistics indicated adequate data fit (RMSEA=.05, CFI=.93, TLI=.91).  As hypothesized, income was associated directly with regimen (β = -.31, p < .001), diabetes-specific parent-child conflict (β = -.43, p < .001), and authoritative parenting (β = .26, p < .001); authoritative parenting was associated with collaborative parent involvement (β = .69, p < .001).  Both parent-child conflict (β =-.47, p < .001) and collaborative parent involvement (β = .24, p < .001) were directly associated with adherence, which was associated with metabolic control (β = -.47, p< .001).  The effect of regimen on HbA1c did not reach statistical significance (β = -.13, p = .08).

Conclusions:Lower family income may deplete parental psychological resources and the quality of parent-child relationships, with adverse effects on diabetes management.

This research was supported by the intramural research program of the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, contract #’s N01-HD-4-3364, N01-HD-4-3361, N01-HD-4-3362, N01-HD-4-3363, N01-HD-3-3360.