Behavioral characteristics of children with type-1 diabetes and the effect of family attitudes on dietary adherence problems

Objective: Assessing the behavioral characteristics and family attitudes of children and adolescents in diabetes is linked to determining the reasons for difficulties in dietary adherence. Our aim was to assess the relationship between behavioral characteristics, family attitudes in children diagnosed with type 1 diabetes mellitus (T1DM), and the dietary adherence and glycemic control. Method: Fifty-four patients T1DM patients and 47 controls aged 7-18 years were included in the study together with their parents. Among the patients diagnosed with T1DM followed in the Pediatric Endocrinology Outpatient Clinic, those with high HbA1c levels (with poor dietary compliance) and those with a HbA1c level below 7.5 (with good dietary compliance) were included in the study as the patient and control group, respectively. A psychiatric assessment interview was conducted with both groups. Sociodemographic data and information on diabetes-related variables, Strengths and Difficulties Questionnaire and Parental Attitude Scale scores were recorded. Results: We have found higher standard diet application rates in patients compared to regular carbohydrate count. The patient group had higher odds of neglecting blood glucose measurement, insulin doses, and a history of stress before decompensation. The rate of psychiatric diagnosis was 26.2%, similar to the general literature, and combined diagnoses were less frequent. Hospital admissions and hypoglycemic episodes were observed at a higher rate in the group that had problems in dietary adherence. Compared to those with good dietary compliance, patients in the dietary non-adherence group had a higher level of parental control and poorer parental perception of their children’s peer relationships. Conclusion: To reduce the risk of acute complications of the disease and to prevent long-term chronic sequelae, it is important to identify positive and some negative behavioral characteristics of child and parental attitudes. Parental role is among the key factors in supporting the autonomy of the child in ensuring dietary compliance.


1. The Society of Endocrinology and Metabolism of Turkey. Clinical Practice Guideline for Diagnosis, Treatment and Followup of Diabetes Mellitus and Its Complications-2019. http://temd. kilavuz7c65cb4e70.pdf. Accessed: July 07, 2019 (Turkish) 2. SEARCH for Diabetes in Youth Study Group, Liese AD, D’Agostino RB Jr, Hamman RF, Kilgo PD, Lawrence JM, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 2006; 118:1510-1518. 3. Levin L, Ban Y, Concepcion E, Davies TF, Greenberg DA, Tomer Y. Analysis of HLA genes in families with autoimmune diabetes and thyroiditis. Hum Immunol 2004; 65:640-647. 4. Mehta SN, Quinn N, Volkening LK, Laffel LM. Impact of carbohydrate counting on glycemic control in children with type 1 diabetes. Diabetes Care 2009; 32:1014-1016. 5. American Diabetes Association. 11. Children and Adolescents. Diabetes Care 2016; 39(Suppl.1):S86-93. 6. Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19(Suppl.27):136-154.

7. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Dworatzek PD, Arcudi K, Gougeon R, Husein N, Sievenpiper JL, Williams SL. Nutrition therapy. Can J Diabetes 2013; 37(Suppl.1):S45-55.

8. DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018; 19(Suppl.27):105-114.

9. Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, Tuomilehto J. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 2000; 23:1516-1526.

10. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160:2101-2107.

11. Riekert KA, Drotar D. Who participates in research on adherence to treatment in insulin-dependent diabetes mellitus? Implications and recommendations for research. J Pediatr Psychol 1999; 24:253-258.

12. Hysing M, Elgen I, Gillberg C, Lie SA, Lundervold AJ. Chronic physical illness and mental health in children. Results from a large-scale population study. J Child Psychol Psychiatry 2007; 48:785-792.

13. Pinquart M, Shen Y. Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. J Pediatr Psychol 2011; 36:375-384.

14. Dantzer C, Swendsen J, Maurice-Tison S, Salamon R. Anxiety and depression in juvenile diabetes: a critical review. Clin Psychol Rev 2003; 23:787-800.

15. Northam EA, Matthews LK, Anderson PJ, Cameron FJ, Werther GA. Psychiatric morbidity and health outcome in Type 1 diabetes- -perspectives from a prospective longitudinal study. Diabet Med 2005; 22:152-157.

16. Leonard BJ, Jang YP, Savik K, Plumbo PM, Christensen R. Psychosocial factors associated with levels of metabolic control in youth with type 1 diabetes. J Pediatr Nurs 2002; 17:28-37.

17. Akbas S, Karabekiroglu K, Ozgen T, Tasdemir G, Karakurt M, Senses A, et al. Association between emotional and behavioral problems and metabolic control in children and adolescents with Type 1 diabetes. J Endocrinol Invest 2009; 32:325-329.

18. Sassmann H, de Hair M, Danne T, Lange K. Reducing stress and supporting positive relations in families of young children with type 1 diabetes: a randomized controlled study for evaluating the effects of the DELFIN parenting program. BMC Pediatr 2012; 12:152.

19. Goodman R, Meltzer H, Bailey V. The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version. Int Rev Psychiatry 2003; 15:173-177.

20. Guvenir T, Ozbek A, Baykara B, Arkar H, Sentürk B, Incekas S. Psychometric properties of the turkish version of the Strengths And Difficulties Questionnaire (SDQ-TUR). Turk J Child Adolesc Ment Health 2008; 15:65-74. (Turkish)

21. Yalın S, Ozbek A, Guvenir T, Baydur H. The advanced psychometric properties of turkish Strengths And Difficulties Questionnaire (SDQ). Turk J Child Adolesc Ment Health 2013; 20:23-32. (Turkish)

22. Lamborn SD, Mounts NS, Steinberg L, Dornbusch SM. Patterns of competence and adjustment among adolescents from authoritative, authoritarian, indulgent, and neglectful families. Child Dev 1991; 62:1049-1065.

23. Yilmaz A. Parenting style scale: reliability and validity. Turk J Child Adolesc Ment Health 2000; 7:160-172. (Turkish)

24. Moore SM, Hackworth NJ, Hamilton VE, Northam EP, Cameron FJ. Adolescents with type 1 diabetes: parental perceptions of child health and family functioning and their relationship to adolescent metabolic control. Health Qual Life Outcomes 2013; 11:50.

25. Williams LB, Laffel LM, Hood KK. Diabetes-specific family conflict and psychological distress in paediatric Type 1 diabetes. Diabet Med 2009; 26:908-914.

26. Bratina N, Forsander G, Annan F, Wysocki T, Pierce J, Calliari LE, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school. Pediatr Diabetes 2018; 19(Suppl.27):287-301.

27. Cho E, Shin SH, Eun SH, Kim JY, Nam HK, Lee KH, et al. Psychological characteristics of Korean children and adolescents with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab 2013; 18:122-127.

28. Blanz BJ, Rensch-Riemann BS, Fritz-Sigmund DI, Schmidt MH. IDDM is a risk factor for adolescent psychiatric disorders. Diabetes Care 1993; 16:1579-1587.

29. Kovacs M, Ho V, Pollock MH. Criterion and predictive validity of the diagnosis of adjustment disorder: a prospective study of youths with new-onset insulin-dependent diabetes mellitus. Am J Psychiatry 1995; 152:523-528.

30. Kovacs M, Goldston D, Obrosky DS, Bonar LK. Psychiatric disorders in youths with IDDM: rates and risk factors. Diabetes Care 1997; 20:36-44.

31. Block WM, Putzer GJ, Jaramillo JR. Children with type 2 diabetes mellitus and the prevalence of psychiatric disorders. South Med J 2010; 103:1214-1218.

32. Sahin N, Oztop DB, Yilmaz S, Altun H. Assessment of Psychopathology, Quality of Life, and Parental Attitudes in Adolescents with Type 1 Diabetes Mellitus. Noro Psikiyatr Ars 2015; 52:133-138.

33. Muslu L, Ardahan M, Gunbayi I. Perceptions of patients with type 2 diabetes mellitus on psychosocial adaptation process: a phenomenological study. Current Approaches in Psychiatry 2017; 9:75-100. (Turkish)

34. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2010; 49:980-989.

35. Goldston DB, Kelley AE, Reboussin DM, Daniel SS, Smith JA, Schwartz RP, et al. Suicidal ideation and behavior and noncompliance with the medical regimen among diabetic adolescents. J Am Acad Child Adolesc Psychiatry 1997; 36:1528- 1536.

36. Northam EA, Matthews LK, Anderson PJ, Cameron FJ, Werther GA. Psychiatric morbidity and health outcome in Type 1 diabetes- -perspectives from a prospective longitudinal study. Diabet Med 2005; 22:152-157.

37. Cummins E, Royle P, Snaith A, Greene A, Robertson L, McIntyre L, et al. Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: systematic review and economic evaluation. Health Technol Assess 2010; 14:1-181.

38. Northam EA, Lin A, Finch S, Werther GA, Cameron FJ. Psychosocial well-being and functional outcomes in youth with type 1 diabetes 12 years after disease onset. Diabetes Care 2010; 33:1430-1437.

39. Scaramuzza A, De Palma A, Mameli C, Spiri D, Santoro L, Zuccotti GV. Adolescents with type 1 diabetes and risky behaviour. Acta Paediatr 2010; 99:1237-1241.

40. Stewart SM, Emslie GJ, Klein D, Haus S, White P. Self-care and glycemic control in adolescents with Type 1 diabetes. Children’s Health Care 2005; 34:239-244.

41. Cameron FJ, Clarke C, Hesketh K, White EL, Boyce DF, Dalton VL, et al. Regional and urban Victorian diabetic youth: clinical and quality-of-life outcomes. J Paediatr Child Health 2002; 38:593-596.

42. Streisand R, Mackey ER, Elliot BM, Mednick L, Slaughter IM, Turek J, et al. Parental anxiety and depression associated with caring for a child newly diagnosed with type 1 diabetes: opportunities for education and counseling. Patient Educ Couns 2008; 73:333-338.

43. Botello-Harbaum M, Nansel T, Haynie DL, Iannotti RJ, Simons-Morton B. Responsive parenting is associated with improved type 1 diabetes-related quality of life. Child Care Health Dev 2008; 34:675-681.

44. Drew LM, Berg C, King P, Verdant C, Griffith K, Butler J, et al. Depleted parental psychological resources as mediators of the association of income with adherence and metabolic control. J Fam Psychol 2011; 25:751-758.

45. Marshall M, Carter B, Rose K, Brotherton A. Living with type 1 diabetes: perceptions of children and their parents. J Clin Nurs 2009; 18:1703-1710.

46. Wilson AC, DeCourcey WM, Freeman KA. The impact of managing school-aged children’s diabetes: the role of child behavior problems and parental discipline strategies. J Clin Psychol Med Settings 2009; 16:216-222.

47. Weinger K, O’Donnell AK, Ritholz MD. Adolescent views of diabetes related parent conflict and support: A focus group analysis. J Adolesc Health 2001; 29:330-336.

48. Carroll AE, Marrero DG. How do parents perceive their adolescent’s diabetes: a qualitative study. Diabet Med 2006; 23:1222-1224.

49. Faulkner MS, Chang LI. Family influence on self-care, quality of life, and metabolic control in school-age children and adolescents with type 1 diabetes. J Pediatr Nurs 2007 ;22:59-68.

50. Dashiff C, Riley BH, Abdullatif H, Moreland E. Parents’ experiences supporting self-management of middle adolescents with type 1 diabetes mellitus. Pediatr Nurs 2011; 37:304-310.

51. Geffken GR, Heather L, Walker KN, Storch EA, Heidgerken AD, Lewin A, et al. Family functioning processes and diabetic ketoacidosis in youths with type I diabetes. Rehabilitation Psychology 2008; 53:231-232.

52. Schafer LC, McCaul KD, Glasgow RE. Supportive and nonsupportive family behaviors: relationships to adherence and metabolic control in persons with type I diabetes. Diabetes Care 1986; 9:179-185.

53. Chisholm V, Atkinson L, Donaldson C, Noyes K, Payne A, Kelnar C. Predictors of treatment adherence in young children with type 1 diabetes. J Adv Nurs 2007; 57:482-493.

Kaynak Göster

  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984

6.1b 3.6b

Sayıdaki Diğer Makaleler

Anxiogenic, memory-impairing, pro-oxidant and pro-inflammatory effects of sodium benzoate in the mouse brain

Anthony Tope OLOFINNADE, Adejoke Yetunde ONAOLAPO, Olakunle James ONAOLAPO

Evaluation of plasma GRP78 levels in patients with autism spectrum disorder


Behavioral characteristics of children with type-1 diabetes and the effect of family attitudes on dietary adherence problems


The Perceived Maternal Parenting Self-Efficay (PMP S-E) Tool: the adaptation study in the context of attachment styles and mood in the first-time mothers


Turkish Version of the Fear of COVID-19 Scale: Validity and reliability study for children and adolescents

Nuran GÖZPINAR, Süleyman ÇAKIROĞLU, Emine Merve KALINLI, Erdem ERTAŞ, Vahdet GÖRMEZ

The relationship between vitamin B12 and vitamin D levels and subjective cognitive complaints in patients with first episode major depressive disorder


Predictive roles of state hope and cognitive control/flexibility in state anxiety during COVID-19 outbreak in Turkey


The role of emotional interference on learning in an emotional probabilistic Go/No-Go task


Pathophysiological correlates of schizophrenia and incidental cerebral periventricular leukomalacia through a patient


Successful treatment with long-acting injectable aripiprazole monohydrate for two patients with dual diagnosis - substance use disorder and psychotic disorder