Mediators of Family Support and Quality of Life in Adolescent Type 1 Diabetes Mellitus: A Systematic Review

Abstract

Background: Adolescents with T1DM face an increased risk of diminished health-related quality of life (HRQOL) due to the daily demands of disease management during a developmentally sensitive period. Family social support has been proposed as a key protective factor, yet its relationship with HRQOL varies across studies, suggesting the involvement of intervening psychosocial and behavioral mechanisms. This systematic review aimed to synthesize evidence on the psychosocial and behavioral factors that mediate the relationship between family social support and HRQOL among adolescents with T1DM.

Method: A systematic search of Scopus and PubMed was conducted following PRISMA 2020 guidelines. Studies were included if they involved adolescents with T1DM, measured family social support and HRQOL, and reported at least one psychosocial or behavioral mediating variable. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in study designs and mediators examined, findings were synthesized narratively.

Results: Fourteen studies involving approximately 1,678 adolescents were included, conducted across eight countries between 2006 and 2026. Seven thematic mediating pathways were identified. Self-efficacy and self-management, emotional and psychological adjustment, and family functioning as a proximal correlate showed the most consistent evidence. Metabolic control, examined in eight studies, showed a positive but mixed pattern. Autonomy, resilience, and peer support were supported by convergent qualitative evidence from two countries. Illness representation was examined in only one study. Methodological quality was acceptable to good across all included studies, with none rated as low quality.

Conclusion: Family social support appears to influence HRQOL among adolescents with T1DM primarily through indirect pathways involving self-efficacy, self-management, and emotional adjustment, consistent with an ecological systems perspective.Given the predominance of cross-sectional designs, these findings should be interpreted as indicative rather than confirmatory. Further longitudinal and mediation-based research, particularly from underrepresented regions, is needed.