Original Article

Children’s Age, Family Conflict, and Children’s HbA1c: Are Girls and Boys Different?

Authors: Miryoung Lee, PhD, MPH, Paul R. Breyer, MD, John M. Pascoe, MD, MPH


Objective: This study examined the relation between children’s sex, age, family conflict, and children’s glycated hemoglobin A1c (HbA1c).

Methods: Parents of children with type 1 diabetes mellitus were recruited from the diabetes clinic of a midwestern children’s hospital. The survey included demographics and the Diabetes Family Conflict Scale (DFCS). The index child’s HbA1c was obtained.

Results: DFCS was significantly associated with HbA1c for both boys and girls (rs = 0.3, P < 0.001); however, girls had significantly higher median HbA1c levels (8.8) than boys (8.4, P = 0.003). Median HbA1c levels in boys younger than 12 years (8.2) were significantly lower compared with girls younger than 12 years (8.7, P = 0.025) or older girls (9.0, P < 0.001). Median DFCS scores were similar for all boys—approximately 25—but families with older girls had significantly higher scores compared with younger girls (27.0 vs 24.0, P = 0.04).

Conclusions: DFCS scores were significantly related to HbA1c levels. Psychosocial factors are related to HbA1c in children with type 1 diabetes mellitus.
Posted in: Endocrinology, Diabetes, and Metabolism10 Diabetes Mellitus5

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1. Pascoe JM, Wood DL, Duffee JH, et al. Mediators and adverse effects of child poverty in the United States. Pediatrics 2016;137:e20160340.
2. Chung EK, Siegel BS, Garg A, et al. Screening for social determinants of health among children and families living in poverty: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care 2016;46:135-153.
3. Rutter M. Achievements and challenges in the biology of environmental effects. Proc Natl Acad Sci USA 2012;109( suppl 2 ):17149-17153.
4. Deng Q, Chen H, Liu Y, et al. Psychological stress promotes neutrophil infiltration in colon tissue through adrenergic signaling in DSS-induced colitis model. Brain Behav Immun 2016;57:243-254.
5. Koopman JS, Lynch JW. Individual causal models and population system models in epidemiology. Am J Public Health 1999;89:1170-1174.
6. Boyce WT, Sokolowski MB, Robinson GE. Toward a new biology of social adversity. Proc Natl Acad Sci USA 2012;109( suppl 2 ):17143-17148.
7. Boyce WT. A biology of misfortune. Focus 2012;29:1-6.
8. Lawes T, Franklin V, Farmer G. HbA1c tracking and bio-psychosocial determinants of glycaemic control in children and adolescents with type 1 diabetes: retrospective cohort study and multilevel analysis. Pediatr Diabetes 2014;15:372-383.
9. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr 1994;125:177-188.
10. Scottish Government Scottish diabetes framework: action plan. https://www.gov.scot/Publications/2006/06/12111211/0. Published 2006. Accessed October 21, 2018.
11. American Diabetes Association. 11. Children and adolescents. Diabetes Care 2016;39( suppl 1 ):S86-S93.
12. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005;54:1615-1625.
13. Anderson BJ, Holmbeck G, Iannotti RJ, et al. Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes. Fam Syst Health 2009;27:141-152.
14. Schwartz DD, Axelrad ME, Anderson BJ. A psychosocial risk index for poor glycemic control in children and adolescents with type 1 diabetes. Pediatr Diabetes 2014;15:190-197.
15. Boyce WT. The lifelong effects of early childhood adversity and toxic stress. Pediatr Dent 2014;36:102-108.
16. Nordwall M, Arnqvist HJ, Bojestig M, et al. Good glycemic control remains crucial in prevention of late diabetic complications-the Linkö Diabetes Complications Study. Pediatr Diabetes 2009;10:168-176.
17. Looman WS. Development and testing of the social capital scale for families of children with special health care needs. Res Nurs Health 2006;29:325-336.
18. Eaton WW, Kessler LG. Rates of symptoms of depression in a national sample. Am J Epidemiol 1981;114:528-538.
19. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:358-401.
20. Hood KK, Butler DA, Anderson BJ, et al. Updated and revised Diabetes Family Conflict Scale. Diabetes Care 2007;30:1764-1769.
21. Miller GE, Chen E, Parker KJ. Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Psychol Bull 2011;137:959-997.
22. Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA 2009;301:2252-2259.
23. Grey M, Boland EA, Davidson M, et al. Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr 2000;137:107-113.
24. Nansel TR, Iannotti RJ, Liu A. Clinic-integrated behavioral intervention for families of youth with type 1 diabetes: randomized clinical trial. Pediatrics 2012;129:e866-e873.
25. Cameron FJ, Northam EA, Ambler GR, et al. Routine psychological screening in youth with type 1 diabetes and their parents: a notion whose time has come? Diabetes Care 2007;30:2716-2724.
26. Schwartz DD, Cline VD, Hansen JA, et al. Early risk factors for nonadherence in pediatric type 1 diabetes: a review of the recent literature. Curr Diabetes Rev 2010;6:167-183.
27. Gallant MP. The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav 2003;30:170-195.
28. Barlow JH, Ellard DR. Psycho-educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base. Child Care Health Dev 2004;30:637-645.
29. Kamps JL, Hempe JM, Chalew SA. Racial disparity in A1C independent of mean blood glucose in children with type 1 diabetes. Diabetes Care 2010;33:1025-1027.
30. Pascoe JM, Stolfi A, Ormond MB. Correlates of mothers' persistent depressive symptoms: a national study. J Pediatr Health Care 2006;20:261-269.