Background Family members’ responses to adults’ diabetes and efforts to manage it vary widely. Multiple aspects of diabetes-specific family functioning have been identified as important for self-management and psychosocial well-being in theoretical (i.e., theories of social support and collaborative coping) and observational literature. Purpose Develop a typological framework of diabetes-specific family functioning and examine cross-sectional associations between type and diabetes outcomes. Methods We used electronic health record (EHR) data to identify a cohort of 5,545 adults receiving outpatient care for type 2 diabetes and invited them to complete a survey assessing 10 dimensions of diabetes-specific family functioning. We used k-means cluster analysis to identify types. After type assignment, we used EHR data for the full cohort to generate sampling weights to correct for imbalance between participants and non-participants. We used weighted data to examine unadjusted associations between participant characteristics and type, and in regression models to examine associations between type and diabetes outcomes. Regression models were adjusted for sociodemographics, diabetes duration, and insulin status. Results We identified and named four types: Collaborative and Helpful (33.8%), Satisfied with Low Involvement (22.2%), Want More Involvement (29.6%), and Critically Involved (14.5%; reflecting the highest levels of criticism and harmful involvement). Across these types, hemoglobin A1c, diabetes distress, depressive symptoms, diabetes medication adherence, and diabetes self-efficacy worsened. After covariate adjustment, type remained independently associated with each diabetes outcome (all p’s < .05). Conclusions The typology extends theories of family support in diabetes and applications of the typology may lead to breakthroughs in intervention design, tailoring, and evaluation.

中文翻译：

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2 型成人糖尿病特定家庭功能类型的发展

背景 家庭成员对成人糖尿病的反应和管理它的努力差异很大。在理论（即社会支持和协作应对理论）和观察文献中，糖尿病特异性家庭功能的多个方面已被确定为对自我管理和社会心理健康很重要。目的 制定糖尿病特定家庭功能的类型学框架，并检查类型和糖尿病结果之间的横断面关联。方法 我们使用电子健康记录 (EHR) 数据确定了 5,545 名接受 2 型糖尿病门诊治疗的成年人的队列，并邀请他们完成一项调查，评估糖尿病特定家庭功能的 10 个维度。我们使用 k-means 聚类分析来识别类型。类型赋值后，我们使用整个队列的 EHR 数据来生成抽样权重，以纠正参与者和非参与者之间的不平衡。我们使用加权数据来检查参与者特征和类型之间未调整的关联，并在回归模型中检查类型和糖尿病结果之间的关联。回归模型根据社会人口统计学、糖尿病病程和胰岛素状态进行了调整。结果 我们确定并命名了四种类型：协作和乐于助人 (33.8%)、对低参与度感到满意 (22.2%)、希望更多参与 (29.6%) 和批判性参与 (14.5%；反映最高级别的批评和有害参与) . 在这些类型中，血红蛋白 A1c、糖尿病困扰、抑郁症状、糖尿病药物依从性和糖尿病自我效能恶化。协变量调整后，类型仍然与每个糖尿病结果独立相关（所有 p < .05）。结论 该类型学扩展了糖尿病中家庭支持的理论，该类型学的应用可能会导致干预设计、定制和评估方面的突破。