Family function, stress, and locus of control. Relationships to glycemia in adults with diabetes mellitus

Arch Fam Med. 1993 Apr;2(4):393-402. doi: 10.1001/archfami.2.4.393.


Objective: To determine whether glycemic control in adults with either insulin-dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) is related to perceived family function, stress/coping, affect, and locus of control.

Design: Cross-sectional, observational study.

Participants: Four hundred seven subjects from a family medicine ambulatory care unit, a tertiary pediatric diabetic unit, or a public-funded community health center, all located in Winston-Salem, NC, completed a series of psychometric instruments that included the Family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve), FACES III (Family Adaptability and Cohesion Evaluation Scales) Cohesion subscale, Affect Balance Scale, Multidimensional Health Locus of Control Scales, and the Brief Encounter Psychosocial Instrument.

Main outcome measure: Glycemic control was measured by fasting blood glucose levels and glycosylated hemoglobin A1C levels as well as by patients' perception of their control.

Results: Those with NIDDM had scores indicative of more external sources of control than those with IDDM. A greater proportion of adults with both subtypes of diabetes perceived their families to be disengaged than subjects from families without diabetes. In a bivariate analysis, family dysfunction correlated with lack of perceived glycemic control, while perceived stress and negative affect correlated with fasting glucose levels in those with NIDDM but not those with IDDM. Using multivariate discriminant analysis, adults with NIDDM in good glycemic control as measured by glycosylated hemoglobin levels had lower family cohesion and negative affect than those in poor control. Conversely, those with IDDM with acceptable glycosylated hemoglobin levels had higher family cohesion, less negative affect, fewer chance loci of control, but higher perception of inadequate coping than those in poor control.

Conclusions: Knowledge of the family function, affect, locus of control, perceived stress, and coping may be useful to the family physician in the care of adults with diabetes mellitus, since these psychosocial parameters are associated with objective and perceived glycemic control.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Aged
  • Blood Glucose
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / prevention & control
  • Diabetes Mellitus, Type 1 / psychology*
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / prevention & control
  • Diabetes Mellitus, Type 2 / psychology*
  • Family*
  • Female
  • Glucose Tolerance Test
  • Glycated Hemoglobin A / analysis
  • Humans
  • Internal-External Control*
  • Life Change Events*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Stress, Psychological*


  • Blood Glucose
  • Glycated Hemoglobin A