This research compares the family environments of diabetic adolescents in good (HbA1c less than 10), fair (10 greater than or equal to HbA1c less than or equal to 14), and poor (HbA1c greater than 14) control. Fifty-eight adolescents diagnosed with type 1 diabetes and their parents (mothers) were independently assessed with structured interviews, the Moos Family Environment Scale, and adolescents also completed the Piers-Harris Children's Self-Concept Scale. As compared with adolescents in poor control, those in good control reported fewer diabetes-related symptoms and had less anxiety and a more positive self-concept. Well-controlled youths also reported more cohesion and less conflict among family members. More parents of well-controlled youths stated that family members were encouraged to behave independently. In addition, more parents of poorly controlled adolescents believed that diabetes had negatively affected the child's personality, physical well-being, schooling, and participation in activities away from home. These findings suggest a complex interplay between the diabetic adolescent's psychological and physical functioning, metabolic control, and the family environment.

Family characteristics of diabetic adolescents: relationship to metabolic control

Identified opportunities to make statistical analysis more closely approximate the conceptual issues that are apparent in current research in pediatric psychology. The paper proceeds by explicating the logic of multivariate analysis and its application to causal modeling. Causal modeling techniques are discussed and the ease of employing these techniques is evaluated. Several articles from earlier issues of this journal are reviewed in terms of the application of causal analysis.

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Causal Analysis: Theory and Application

Stress has long been suspected as having major effects on metabolic activity. The effects of stress on glucose metabolism are mediated by a variety of "counter-regulatory" hormones that are released in response to stress and that result in elevated blood glucose levels and decreased insulin action. This energy mobilizing effect is of adaptive importance in a healthy organism. However, in diabetes, because of a relative or absolute lack of insulin, stress-induced increases in blood glucose cannot be adequately metabolized. Thus, stress is a potential contributor to chronic hyperglycemia in diabetes, although its exact role is unclear. Although there is some suggestion from retrospective human studies that stress can precipitate type I diabetes, animal studies are contradictory with different stressors either having facilitatory or inhibitory effects upon the development of the disease. Human investigations in patients with established diabetes are equally confusing with some showing that stress can stimulate hyperglycemia, hypoglycemia or have no effect at all on glycemic status. There is more consistent evidence supporting the role of stress in animal models of type II diabetes. However, human studies on the role of stress on the course of established type II diabetes are few. Intervention studies suggest that behavioral or pharmacologic intervention to manage stress may contribute significantly to diabetes treatment, but more long-term research is needed. It is concluded that further research is needed to establish the importance of behavioral factors in the etiology and management of diabetes, and several areas of methodologic improvement are suggested.

Role of stress in the etiology and treatment of diabetes mellitus

Although plasma lipid levels are assumed to reflect the individual's constitutional or nutritional status, many studies have found that plasma lipids are noticeably influenced by short-term emotional arousal. Sixty such studies are reviewed. These studies span a remarkable breadth of stressful situa

Variability of plasma lipids in response to emotional arousal.

Studies assessing (1) the influence of psychosocial factors on the onset of juvenile diabetes, (2) the influence of psychosocial factors on the course of this disease, and (3) the influence of diabetes on the psychosocial development of the child are reviewed. Directions for future research are suggested.

Psychosocial factors in juvenile diabetes: a review.

Beta adrenergic blockade and juvenile diabetes: acute studies and long-term therapeutic trial. Evidence for the role of catecholamines in mediating diabetic decompensation following emotional arousal.

Avner Barcai

Papers

Beta adrenergic blockade and juvenile diabetes: acute studies and long-term therapeutic trial. Evidence for the role of catecholamines in mediating diabetic decompensation following emotional arousal.