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05-28-2019 | Children | Highlight | News

Maternal education has major impact on glycemic control in children

medwireNews: Researchers report that women’s educational attainment is strongly associated with the glycated hemoglobin (HbA1c) levels of their children with type 1 diabetes.

The differences “were large and clinically relevant,” and were not present at diagnosis, but began to appear within 6 months of living with diabetes and persisted for 5 years of post-diagnosis follow-up.

“[O]ur results suggest that it may be beneficial to provide extra support to the least privileged children during the first few years of diabetes,” write Nick Nielsen (University of Copenhagen, Denmark) and co-researchers in Diabetes Care.

The team grouped 4079 children according to their mothers’ level of education and found that the average HbA1c level during follow-up was 68.7 mmol/mol (8.4%) in the group whose mothers had a high school education, compared with 59.7 mmol/mol (7.6%) in the group whose mothers had a Master’s degree or more. Children whose mothers had intermediate education had intermediate HbA1c levels.

A potential explanation for these differences was the number of glucose tests conducted per day, which was higher with higher maternal education.

The difference in the number of glucose tests was evident from 6 months after diagnosis, and widened over the next 6 months, to approximate averages of 6.75 and 5.55 tests/day in the groups with the highest versus the lowest levels of maternal education, respectively, although it then declined over time in all groups. The differences in HbA1c levels according to maternal education were most prominent among children who tested only three times/day or fewer.

The researchers found that 41.2% of the HbA1c difference between the groups with the most and least educated mothers was explained by observable variables, with 22.5% of the gap explained by frequency of daily blood glucose tests.

But Nielson and team stress that “this is not the full story,” noting that “considerable differences across groups remained even when the number of daily blood glucose tests was held fixed.”

They say: “Potential explanations for the remaining differences are that highly educated mothers may be more capable of helping with diabetes management, be more able to educate their children in how to control their diabetes, and have increased focus on (to us) unobserved aspects of treatment and adherence.”

Other factors that explained a smaller proportion of the HbA1c gap between groups were living with both parents (6.0%), mother’s employment status (3.3%), diabetes duration (3.4%), and number of siblings (1.7%).

Maternal education was also significantly associated with risk for diabetic ketoacidosis and severe hypoglycemia, although most of the association disappeared after full adjustment for multiple variables including parental type 1 diabetes, immigrant status, and treatment regimen. The number of daily glucose tests was associated with risk for ketoacidosis but not severe hypoglycemia.

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetes Care 2019; doi:10.2337/dc19-0184

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