Relationship between Family Life Cycle and Glycemic Control in Patients with Type 2 Diabetes Mellitus in Durango, Mexico

Research Article

J Fam Med. 2018; 5(4): 1148.

Relationship between Family Life Cycle and Glycemic Control in Patients with Type 2 Diabetes Mellitus in Durango, Mexico

Diaz-Alfaro JA1, Rivas-Gonzalez MA2, Simental- Mendia LE3, Neri-Aragon IA4, Corral-Mendoza N5 and Ramirez-Leyva DH6*

¹Department of Family Medicine, General Hospital Zone #1 (IMSS), Durango Delegation, Mexico

²Department of Family Medicine, Family Medicine Unit #49 (IMSS), Durango Delegation, Mexico

³Biomedical Research Unit (IMSS), Durango Delegation, Mexico

4Department of Family Medicine, Family Medicine Unit #44 (IMSS), Durango Delegation, Mexico

5Department of General Medicine, Xochicalco University, Baja California Delegation, Mexico

6Department of Family Medicine, Family Medicine Unit #37 (IMSS), Sinaloa Delegation, Sinaloa, Mexico

*Corresponding author: Ramirez-Leyva Diego Hazael, Department of Family Medicine, Family Medicine Unit #37 (IMSS), Sinaloa Delegation, México

Received: August 12, 2018; Accepted: September 07, 2018; Published: September 14, 2018


Background: Type 2 diabetes mellitus (T2D) is one of the most frequent chronic diseases. The prevalence of T2D in people 20 years of age or older in Durango is 10.2%. A family who have a chronically ill family member (T2D), has to face significant alterations that occur mainly at the level of structure and family vital cycle, within these changes, glycemic control plays a very important role in the evolution of the disease.

Aim: The purpose of this study is to determine the association between family life cycle and glycemic control in families of Durango, Mexico.

Design and Setting: Comparative cross-sectional study.

Methods: In 209 patients in the General Hospital Zone #1, Durango, Mexico, patients were divided into two groups, with and without glycemic control to make an association in search of associated sociodemographic and family factors in T2D. For statistical analysis, association was established with chisquared test and ANOVA for statistical significance, it was used 95% interval confidence (p‹0.05).

Results: The association of sociodemographic and family variables with glycemic control was: sex (p=0.55), marital status (p=0.02), educational stages (p=0.91), family vital cycle (p=0.20). The association between HbA1c (glycemic control) and family vital cycle phase showed an association in the uncontrolled group and independence and retirement and death phase (p=0.02).

Conclusion: Family life cycle is not associated with glycemic control in patients with type 2 diabetes. Since the findings are controversial, more studies with multiple variables are required.

Keywords: Family Vital Cycle; Type 2 Diabetes; Glycemic Control


Type 2 diabetes mellitus (T2D) is one of the most frequent chronic diseases, its progressive and uncontrolled increase is considered a public health problem worldwide [1]. In Mexico, T2D occupies first place as a cause of mortality and its trend shows a progressive increase in recent years, it is estimated that the death rate grows 3% every year. The prevalence of T2D in people 20 years of age or older in Durango is 10.2%, a percentage higher than reported in the Encuesta Nacional de Salud y Nutricion (ENSANUT) in 2006 (7.4%) [2]. In comparison with national results, the prevalence of diabetes in Durango was above the national average (9.17%) [2].

Previous information has demonstrated an increasing number of people and families facing the process of diagnosis, treatment and the process of adaptation learning to live with a chronic illness in a family member. There is an essential necessity for health professionals to prepare with specific knowledge to manage properly the impact that this type of illness generates in the family environment. To have a better understanding we can define that family is a social group, organized as an open system, constituted by a variable number of members, who in the majority of cases cohabit in the same place, they can be linked by consanguineous, legal or affinity ties. Family is a primary building block for the proper development of the somatic and cognitive building structure of the human being and all its surroundings. One of the fundamental family objectives is to be responsible for guiding and protecting its members, family structure is also very important for the family functions, provides the ability to diversify and adapt to adverse conditions, as well as being the unit of analysis in the Family Medicine practice that fort the study and a better understanding of the health-disease process [3].

Like all living organisms, family system tends to the conservation and evolution; the demands of change activate the mechanisms that counteract atypical elements and the system evolves towards an increasing complexity. Although family usually fluctuates within certain limits, it has an immense capacity to adapt and change, maintaining key elements of continuity. Family, therefore, is considered a social cell, whose membrane protects its individuals inside and relates them to the outside. Family reproduces, declines and also dies [4]. The most significant alterations that can be found, from the systemic point of view of a family who have a chronically ill family member, occur mainly at the level of structure, evolution of the family cycle and its emotional response [4-5]. Family life goes through a cycle of birth, growth and decline. From this theoretical perspective, a cycle begins when two people form a couple and ends with the dissolution of the union when one dies, without forgetting that during this period, families expand or reduce, as their children join or leave them.

The family life cycle involves traversing by stages necessary according to the evolutionary moments of the family, and also of the development and personal contribution of those who comprise it. Therefore, the cycle transforms according to the needs of the group over time. Family, like individuals, evolves through several phases that are commonly known as the family evolutionary cycle. This cycle includes the expected transitions or life events that most families go through during their development, in a sequence that is quite predictable, but also variable, and includes coping with the social, economic, socio-demographic and political changes that surge on the daily basics [6].

Chronic diseases, due to their long-term evolution, can occur through all phases of the family's evolutionary cycle, from the expansion phase to the retirement and death phase, the facing of chronic disease are a real challenge for the whole family nucleus, including economic, educational, mental, emotional, physical and social factors. Due to the previous knowledge, the objective of this study is to determine the association between family life cycle and glycemic control in families of Durango, Mexico.

Materials and Methods

A comparative cross-sectional study was carried out, in the General Hospital of Zone #1, of the Instituto Mexicano del Seguro Social (IMSS), located in Durango, Mexico; in patients which were selected by a consecutive sampling techniques; that met the following inclusion criteria: age between 30 to 75 years, with diagnosis of type 2 diabetes, that accepted and signed an informed consent, with at least one glycosylated hemoglobin (HbA1c) in the last three months; patients with psychiatric illness and chronic renal failure were not included and eliminated those who did not complete the survey or those with incomplete information.

The following data were obtained directly from the patients or medical records: age, sex, marital status, educational stages, glycemic control (HbA1c) and family vital cycle. The procedure for the data collection was as follows: age was calculated in years according to the year of birth, sex was determined by the phenotype characteristics of each individual, marital status was expressed by each patient, education was determined by asking the last degree of studies, glycemic control was evaluated according to the recommendations of the American Diabetes Association (ADA) with HbA1c, we considered controlled values those who had a HbA1c ‹7%. Family vital cycle was based on Geyman’s life cycle, developed by this same author in 1980 [7]. Glycosylated hemoglobin was taken from a venous blood sample with an 8 hour fasting in an AU-480 chemistry system.

The recollected data was integrated into data collection sheets and analyzed using the SPSS program version 20 in Spanish, where we applied descriptive statistics; for qualitative variables, frequencies and percentages were used and for quantitative variables, mean and standard deviation were used. For the bivariate analysis, the Chisquare test was used in the dichotomous qualitative variables; in the quantitative variables an Analysis of Variance (ANOVA) was used to determinate statistically significant differences between the groups of the family life cycle and glycemic control. The Kolmogorov-Smirnoff test was used to establish the normality of the data. It was considered a p< 0.05 as statistically significant, with a 95% confidence interval. The Protocol was authorized by the Local Committee of Research and Ethics in Health Research from the Regional General Hospital #1, where this study took place.


We analyzed a sample of 209 patients, of whom 161(77%) were women and 48(23%) men. The average age was 58±10.3. The most frequent marital status was married (65%) and 113(54%) had a primary education. The sociodemographic characteristics are described in table 1. Groups were classified according to glycemic control (HbA1c ‹7%) in controlled (n=88) and uncontrolled (n=121). The family life cycle according to Geyman was classified as follows (Graphic 1): in the uncontrolled group 22 families in dispersion phase (11%), 93 families going through independence phase (44%) and 94 families in phase of retirement and death (45%). In the controlled group 15% families in dispersion phase, 44% families in independence phase and 41% families in phase of retirement and death. No families were found in the phase of marriage or expansion in any group.