Demographic risk factors, mediators, and moderators in youths' diabetes metabolic control.

BACKGROUND: Socioeconomic status (SES) is one of the most frequently identified and potent predictors of disease morbidity and mortality. It also predicts diabetes care and metabolic control, yet it is often confounded with parental marital status and ethnicity in pediatric samples.
PURPOSE: Key demographic risk factors for poorer metabolic control in adolescents with type I diabetes are examined to distinguish their relative effects, along with disease care mediators and family environment moderators. METHODS AND
RESULTS: When SES, ethnicity, and marital status are considered simultaneously with path analysis, living with married biological parents is the sole predictor of better metabolic control in a predominantly middle-class sample. Specifically, adolescents who lived with their biologic parents had glycosylated hemoglobin levels that were approximately .5% lower on average than those who lived in alternative family arrangements (i.e., blended and single-parent families). More frequent meals and snacks and more blood glucose monitoring mediates this effect. Under favorable conditions of greater familial harmony, children from married biologic families experience a stronger beneficial health effect, with average glycohemoglobin levels that are approximately .81% lower in less conflicted families and .62% lower in more cohesive families.
CONCLUSIONS: In toto, marital status eclipsed the well known effects of SES in the prediction of metabolic control in a primarily middle-class sample of children with diabetes. The 8.0% average glycohemoglobin level of youths from married biologic families is similar to that of intensively treated adolescents in the Diabetes Control and Complications Trial and, if maintained, should be associated with clinically significant reductions in disease complications.