Diabetes-Specific Family Conflict and Blood Glucose Monitoring in Adolescents With Type 1 Diabetes: Mediational Role of Diabetes Self-Efficacy

Purpose. To determine whether the association between diabetes-specific family conflict and self-monitoring of blood glucose (SMBG) frequency is mediated by diabetes self-efficacy. Methods. A total of 276 adolescents with type 1 diabetes (aged 15.6 ± 1.4 years; duration of diabetes 6.6 ± 1.8 years; A1C 8.9 ± 1.8%) completed measures of diabetes-specific family conflict and self-efficacy. Sociodemographic, family, and disease characteristics (including SMBG frequency and glycemic control) were obtained at the clinic visit. Results. Multivariate analyses were used to test the mediational role of self-efficacy. The first model established that family conflict was associated with lower levels of self-efficacy. The second model established that increased family conflict was associated with lower SMBG frequency. In the third model, self-efficacy was added, and the effect of family conflict on SMBG frequency became less significant (P = 0.001 to P = 0.03). The indirect effect of family conflict on SMBG frequency through diabetes self-efficacy was significant (Sobel = 2.10, P = 0.035) and explained 22% of the association between family conflict and SMBG frequency. Conclusions. Results confirm a partial mediational role of diabetes self-efficacy and suggest that a family environment characterized by conflict may also contain poorer self-efficacy in the adolescent. In these cross-sectional analyses, both variables contributed to less frequent SMBG. Future longitudinal research to confirm these relationships and potential avenues for intervention are discussed.