Family involvement affects adults’ management of T2D. Profiles of diabetes-specific family functioning across multiple interrelated dimensions can provide a more complete picture than any single measure.

We queried EMR data to send eligible outpatient adults with T2D a survey link and obtain deidentified data. Participants completed measures of diabetes-specific family functioning (collaborative coping, helpful and harmful involvement, criticism, autonomy support, effectiveness, satisfaction), diabetes distress (Problem Areas in Diabetes-5), and adherence (Adherence to Refills and Medications Scale for Diabetes). K-means clustering identified types with >70% stability. We used sampling weights to correct for imbalance between participants and non-participants in regression models examining associations between type and outcomes, adjusted for sociodemographics, diabetes duration, and insulin status.

Eleven percent (495/5545) of eligible patients accessed the survey and 379 participated. Half were female, 80% were white, with median [IQR] age 59 [50, 67] years, and EMR A1c values taken -9 [-77, 34] days from the survey were 6.9% [6.2, 7.8]. Four types were identified and named: Happily Involved (high collaboration and helpful involvement, high effectiveness and satisfaction), Don’t Need ‘Em (very low collaboration and involvement, low effectiveness and high satisfaction), Feel Alone (very low involvement, effectiveness and satisfaction); and Critically Involved (very high criticism and harmful involvement, moderate effectiveness and satisfaction). Type was independently associated with diabetes distress, adherence, and A1c (all p<.01). Happily Involved and Critically Involved had best and worst outcomes, respectively (all p<.05).

Our empirical typology of diabetes-specific family functioning is relevant to adults’ diabetes distress, adherence, and glycemic control. Types can be used to inform intervention development, tailoring, and evaluation.


L.S. Mayberry: None. R.A. Greevy: None. L. Huang: None. S. Zhao: None. C. Berg: None.


National Institutes of Health (R03DK113329, K01DK106306)

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