Managing psychosocial issues in a family with diabetes.

Managing diabetes in a child or teen requires constant attention and adjustment of insulin, carbohydrate intake, and activity level. Intensive diabetes management has the potential to improve diabetes outcomes; however, negotiating the many lifestyle accommodations essential to optimal diabetes control can place a significant burden on some children and families. Parenting a child with diabetes also involves a complex process of helping the child to achieve age-appropriate independence while assuring the child's safety in managing his or her diabetes. Each developmental stage brings new challenges to achieving the delicate balance between optimal diabetes control and age-appropriate independence in self-care management. Despite the laborious and intensive nature of diabetes treatment, an overarching goal of parenting a child with diabetes is to ensure that the family's quality of life is maintained and the child is able to participate in all academic and social activities that their peers enjoy. Although many families adapt and thrive, others struggle to make these adjustments. Working with families who are overwhelmed, encouraging them to identify and develop networks involving schools, extended family, community, and church groups can help them to increase available support. Helping families to access treatment when they are struggling can relieve further pain and improve management adherence and diabetes outcomes. Nurses are in a key position to evaluate the family's adaptive and coping skills and assist them to negotiate the psychosocial challenges that living with diabetes entails.

Parents' perceptions of factors that affect successful diabetes management for their children.

OBJECTIVE: To learn which factors parents perceive to be most influential in determining successful type 1 diabetes management. METHODS: A 4-stage mixed qualitative-quantitative method that consists of a series of focus groups, a survey, and in-depth interviews was used to ensure that parents generated, prioritized, and explained their own ideas. In each stage, parents offered a new level of insight into their perception of how children achieve good metabolic control while living as normal a life as possible. The survey responses were divided into statistically different ranks, and the Kruskal-Wallis test was used to compare the results between subgroups. RESULTS: A total of 149 parents participated in the formative qualitative phases, 799 families (66%) responded to the parent-generated survey, and 67 explanatory interviews were conducted. The families who responded to the survey had children of varied ages (mean: 11.9 years; SD: 4.44) and diabetes control (mean hemoglobin A1c: 8.22%; SD: 1.65); 84.1% of respondents were white, 12.3% were black, and 89% were privately insured. The 30 survey items were statistically discriminated into 8 ranks. The items cover a wide range of categories, including concrete ways of achieving better control, families' or children's traits that affect coping ability, actions of the health care team that support versus undermine families' efforts, and the availability of community supports. No clear pattern emerged regarding 1 category that parents perceived to matter most. CONCLUSIONS: Clinicians can affect many of the factors that parents perceive to make a difference in whether they can successfully raise a resilient child in good diabetes control. Future research needs to determine whether health care teams that address the concerns that parents raised in this study are more effective in guiding children to cope well with diabetes, to incorporate healthier lifestyles, and ultimately to achieve better metabolic control.