For patients, parents, and health care providers, managing type 1 diabetes can be quite a challenge, particularly during adolescence. A very interesting article in the August 2011 issue of Diabetes Care offers some insights into how parenting style might play an important role in efforts to achieve optimal diabetes control in adolescents. The study was entitled “Role of Parenting Style in Achieving Metabolic Control in Adolescents with Type 1 Diabetes ,” and written by Maayan Shorer and colleagues (Diabetes Care 2011;34:1735-37). Parents of 100 adolescents with type 1 diabetes completed questionnaires designed to assess parenting style. Both parents and patients rated patient adherence to the treatment plan. Glycemic control was assessed by hemoglobin A1c (HbA1c) determinations.
The investigators found that an authoritative parenting style was associated with better adherence to the treatment plan and lower HBA1c levels than was an authoritarian parenting style. I had actually never heard the term “authoritative parenting style” before. This parenting style is characterized by a parent who sets clear limits for the child in a noncoercive way. This parenting style is to be distinguished from a permissive parenting style and an authoritarian parenting style. The latter style is characterized by harsh, coercive, and punitive parenting. The investigators found that only in fathers did the authoritative parenting style reap benefits for the child. Among the mothers, a permissive parenting style was associated with less well controlled diabetes as was an authoritarian style. For both mothers and fathers, a sense of helplessness was associated with less well controlled diabetes (for fathers) and poorer adherence to treatment (for mothers). The investigators concluded that their study results were consistent with previous studies on parenting style in adolescents with diabetes and that more involvement by fathers who exhibit an authoritative style of parenting would be beneficial.
Translation of these research results to patient care?
These data may explain differences in glycemic control among adolescents with diabetes, but can the information be used to actually improve glycemic control in adolescent patients? That study has yet to be carried out. For now, it makes good sense to work with mothers and fathers of children with diabetes and strive to promote authoritative parenting styles (as opposed to permissive or authoritarian styles) and in particular, to promote more involvement by fathers in the care of their children and adolescents with diabetes. In closing, I must confess that I have no idea how to teach parents to be authoritative rather than authoritarian or permissive in dealing with their teenagers, nor do I know if it can actually be taught. effectively. But, it seems to be worthwhile to try. I wonder what kind of a parent I was to my children when they were teens? Maybe I don’t want to know?
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