Family typology for adults with type 2 diabetes: Longitudinal stability and validity for diabetes management and wellbeing

Objective: We validated longitudinally a typology of diabetes-specific family functioning (Collaborative and Helpful, Satisfied with Low Involvement, Want More Involvement, Critically Involved) in adults with type 2 diabetes.

Research Design and Methods: We conducted k-means cluster analysis with nine dimensions to determine if the typology replicated in a diverse sample and type assignment was robust to variations in sampling and included dimensions. In a subsample with repeated assessments over 9 months, we examined stability and validity of the typology. We also applied a multinomial logistic regression approach to make the typology usable at the individual-level, like a diagnostic tool.

Results: Participants (N=717) were 51% male, over one-third reported minoritized race or ethnicity, mean age was 57 and mean HbA1c was 7.9% (63 mmol/mol) [8.7% (72 mmol/mol) for longitudinal subsample]. The typology replicated with respect to the number of types and dimension patterns. Type assignment was robust to sampling variations (97% consistent across simulations). Type had an average 52% stability over time within participants; instability was not explained by measurement error. Over 9 months, type was independently associated with HbA1c, diabetes self-efficacy, diabetes medication adherence, diabetes distress, and depressive symptoms (all p-values<0.05).

Conclusions: The typology of diabetes-specific family functioning replicated, and longitudinal analyses suggest type is more a dynamic state than stable trait. However, type varies with diabetes self-management and wellbeing over time as a consistent independent indicator of outcomes. The typology is ready to be applied to further precision medicine approaches to behavioral and psychosocial diabetes research and care.