Objective To explore the developmental process and stage characteristics of family participation in disease management among adolescents with type 1 diabetes, and to provide evidence for family participation in disease management. Methods Using purposive sampling, semi-structured interviews were conducted with 20 adolescents with type 1 diabetes and 20 primary caregivers. Data were analyzed using the paradigm model of procedural Grounded Theory to extract concepts and categories. Results A total of 22 initial categories and 4 core categories were identified, and four dynamic evolutionary stages were formed:the shock stage, the conflict stage, the reconstruction stage, and the maintenance stage. Conclusion Family participation in disease management among adolescents with type 1 diabetes is a multi-stage and dynamic process influenced by both internal family inte-ractions and external support systems. Stage-specific and stratified interventions should be developed based on the core needs of each stage to optimize disease management outcomes.