Who Does What? Transferring Diabetes Care Responsibilities from Parents to Children
Jori Aalders, Frans Pouwer, Esther Hartman & Giesje Nefs
A Conceptual Model for Understanding the Division and Transfer of Diabetes Care Responsibilities Between Parents and Children with Type 1 Diabetesy. Healthcare (Basel). 2025 May 14;13(10):1143.
Managing type 1 diabetes (T1D) in children involves a complex set of daily tasks — glucose monitoring, insulin dosing, meal planning, hypo-/hyperglycaemia responses, supply management, and more. In paediatric diabetes, these tasks are often shared between parent(s) and child. As children grow, families face the challenge of dividing and eventually transferring diabetes-care responsibilities in a way that balances safety, autonomy, and developmental needs. Despite its importance, a unified theoretical model to guide and understand how this division and transfer should occur — and how to evaluate its success — has been lacking.
This article presents a narrative review of quantitative and qualitative studies, previous reviews on chronic illness management in children, and established developmental/parenting theories. The authors synthesize this literature to propose a conceptual model that captures the dynamics of who does diabetes-care tasks (parents or child), how and when responsibility is transferred, and which factors influence this process.
Key findings:
- Definition of terms: The authors clearly distinguish between division of care responsibilities (who performs tasks at a given time) and transfer of responsibilities (the process of moving responsibilities from parent to child over time).
- Determinants are multiple and interrelated: The division/transfer depends not only on child’s age or diabetes skills, but on a complex interplay of child factors (cognitive, emotional development; self-efficacy; diabetes-specific skills), parental factors (readiness to relinquish control; attitudes; stress), and contextual factors (school, peer support, healthcare support, family life, socioeconomic context).
- Readiness alignment matters: Optimal transfer seems to depend on alignment between child’s readiness and parental readiness. A child might be capable, but parents may not be ready — or vice versa — leading to conflict or suboptimal transfer timing.
- Multiple outcomes to define “success”: Success of a division/transfer should be evaluated not only on biomedical outcomes (glycaemic control, hypo/hyperglycaemia, complications) but also behavioural (adherence, self-care), emotional (quality of life, autonomy), and relational (parent–child communication, conflict, connectedness) outcomes.
- A flexible, dynamic model: The proposed model reflects that transfer is rarely linear — it can involve back-and-forth, gradual shifts, temporary regressions, and depends on changing circumstances. The model uses bidirectional arrows between child, parent, and context characteristics to reflect this complexity.
Concluding, the authors state
"The division of responsibilities is a multifaceted process that appears to be affected by a complex interplay of child, parent and context characteristics." -
Please click here for the full text pdf.