By Linda Carroll

(Reuters Health) – Children with type 1 diabetes who grow up in families that are close and affectionate are more likely to flourish as adults, a new study suggests.

Based on surveys of over 400 young adults who developed type 1 diabetes as children, researchers found that adult flourishing depended more on past family connectedness than on how well the diabetes was controlled in the present.

“The concept of flourishing has to do with a number of elements, among them: whether a person thinks life has a purpose and meaning; whether they accept who they are, their strengths and weaknesses; and whether they have positive relationships with others,” said coauthor Dr. Robert Whitaker, a professor of clinical pediatrics at Columbia University’s Vagelos College of Physicians and Surgeons in New York City.

Whitaker believes the study’s implications extend beyond one disease. “As we move to the end of the lifecycle, we see that chronic disease is almost an inevitability,” he explained. “If you look at older people who are flourishing in the face of chronic disease you see the same markers. They are still living with purpose and meaning; they are aware each day of their changing limitations, but also of their strengths, including wisdom gained over time; and they’re always engaged in positive relations with others.”

To look at whether early family life had an impact on flourishing in adults with type 1 diabetes, Whitaker and his colleagues analyzed results from an online survey of 415 patients, whose average age was 25, receiving care at the Naomi Berrie Diabetes Center at Columbia.

The survey asked questions to assess the connectedness of respondents’ early family lives, focusing on their relationship with parents, including, for example: “How much could you confide in her/him about things that were bothering you?”, “How much effort did she/he put into watching over you and making sure you had a good upbringing?” and “How much did she/he teach you about life?”

To assess flourishing, the survey asked questions covering six categories: purpose in life, self-acceptance, positive relations with others, personal growth, environmental mastery and autonomy. The maximum possible score for flourishing was 294.

The researchers divided participants into three groups depending on their level of family connectedness during childhood. Those in the lowest third of connectedness had an average flourishing score of 201, as compared to those in the middle third, with 225.2, and those in the highest third, with 240.4.

The pattern was similar even when participants were poor as kids, or had experiences of serious childhood adversity in addition to diabetes, according to the report in JAMA Network Open.

Carol Ryff, director of the Institute on Aging at the University of Wisconsin in Madison, who developed the scales of wellbeing used to assess flourishing, called the study a “model of innovative health science for the future” and a “breath of fresh air.”

First, Ryff said in an email, the study begins with a notable health problem, childhood-onset type 1 diabetes. Second, it places that challenge in the context of other adverse childhood experiences, which are the kinds of precursors typically studied for their role in compromising subsequent health and wellbeing.

“Despite early-onset chronic disease, possibly combined with other early life challenges, those who experienced high-quality parenting showed higher profiles of flourishing,” Ryff said. “In short, these findings offer powerful and hopeful news about the critical role of caring and affectionate parenting in fostering multifaceted flourishing years later, despite childhood disease and other adversities.”

SOURCE: JAMA Network Open, online March 5, 2020.