Child and Parental Adjustment to Type 2 Diabetes

Research on parent and child adjustment to type 2 diabetes is scant, especially considering the rising incidence of the disease (Naughton et al. 2008). One area of research has focused on health-related quality of life (HRQOL). Quality of life is thought to be an important factor in adjustment to the illness and has consequently been increasingly studied in patients with diabetes (e.g., de Wit et al. 2007). For instance, Pediatric Quality of Life Inventory scores were used to compare 91 children and adolescents with type 2 diabetes with approximately 300 healthy controls; children with type 2 diabetes were found to have lower total health, psychosocial health, emotional functioning, social functioning, and school functioning scores (Varni et al. 2003). Another study comparing HRQOL in 257 individuals ages 8-22 years with type 2 diabetes and 2,188 same-age individuals with type 1 diabetes also revealed that participants with type 2 diabetes had lower HRQOL (Naughton et al. 2008).

Moreover, compared with individuals with type 1 diabetes, children and adolescents with type 2 diabetes have been shown to have a higher likelihood of being obese, being from an ethnic-minority group, and having lower socioeconomic status (Brody et al. 2008; Degazon and Parker 2007). Therefore, these individuals present with additional challenges beyond their illness. Discrimination and disparities in health care resources for ethnic minorities are well documented (Ahmed et al. 2007). Additionally, individuals who are obese have been shown to have psychological and emotional problems such as depression, low self-esteem, and discrimination (Braet et al. 1997; Miller and Downey 1999; Puhl and Brownell 2001). In a chart review of pediatric patients in Philadelphia, comorbid neuropsychiatric disorders, including attention-deficit/hyperactivity disorder, autism, bipolar disorder, obsessive-compulsive disorder, and depression (among others), were found in 19.4% of children at the initial onset of type 2 diabetes (Levitt Katz et al. 2005). These conditions are likely to further reduce a child's ability to adjust to a diagnosis of type 2 diabetes.

Very little is currently known about parental adjustment to a child's diagnosis of type 2 diabetes. In a study that is not completely reflective of parental adjustment, Allan et al. (2008) found several differences between children's and parents' perceptions of quality of life. Specifically, parents' scores were lower than children's scores on quality of life, physical functioning, psychosocial functioning, emotional functioning, social functioning, and school functioning. The authors posit that this pattern indicates that parents perhaps believe that the illness has a larger negative impact on their children than the children themselves do. More research is needed to determine if the transactional association of parental distress and child distress found in type 1 diabetes (Beardslee et al. 1983; Burge and Hammen 1991) also exists in type 2 diabetes.

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