Juan Carlos Muñoz-Cruz, Catalina López-Martínez, Rafael Del-Pino-Casado
Parental monitoring is consistently and positively associated with therapeutic adherence in adolescents and young adults with T1DM. Although effect sizes were small to moderate and studies were cross-sectional, the findings support the clinical relevance of collaborative and non-intrusive parental supervision. Family-centred interventions promoting adaptive monitoring may help mitigate the decline in adherence during adolescence.
AIM: To synthesise and quantify the association between parental monitoring and therapeutic adherence in adolescents and young adults (10-24 years) with Type 1 Diabetes Mellitus (T1DM).
METHODS: We conducted a systematic review with meta-analysis following PRISMA guidelines (PROSPERO: CRD420251231615). Searches were conducted in PubMed, CINAHL, SCOPUS, and PsycINFO up to June 2026. Observational studies examining the association between parental monitoring (active supervision of diabetes self-management) and multidimensional therapeutic adherence in individuals aged 10-24 years with T1DM were included. Random-effects models were used to pool correlation coefficients. Heterogeneity (I2), publication bias (Egger's test and trim-and-fill method), and sensitivity analyses were assessed. Methodological quality and certainty of evidence were evaluated using predefined criteria and GRADE principles.
RESULTS: Eight studies (8 independent samples; N = 1209) met inclusion criteria. All the studies were cross-sectional and conducted in the United States. The pooled analysis showed a significant positive association between parental monitoring and therapeutic adherence (r = 0.286; 95% CI: 0.232-0.337), with no statistical heterogeneity. Findings were consistent across informants (parent- or adolescent-reported) and remained robust in sensitivity analyses. Risk of publication bias was low and did not materially affect the estimates. Overall certainty of evidence was moderate.
CONCLUSION: Parental monitoring is consistently and positively associated with therapeutic adherence in adolescents and young adults with T1DM. Although effect sizes were small to moderate and studies were cross-sectional, the findings support the clinical relevance of collaborative and non-intrusive parental supervision. Family-centred interventions promoting adaptive monitoring may help mitigate the decline in adherence during adolescence.