medwireNews: Factors associated with poor glycemic control in children with type 1 diabetes generally vary according to the insulin regimen used, but family conflict over diabetes management universally impacts all insulin users, US researchers report.
Lydia Snyder (Nemours Children's Health System, Jacksonville, Florida) and colleagues say their study, which they believe “is the largest Type 1 diabetes cohort examination of diabetes-related family conflict,” highlights “the importance of screening for and addressing family conflict in all children with Type 1 diabetes.”
They add: “Implementation of interventions to reduce diabetes-related family conflict is important given it is one of the potentially modifiable factors in the home environment that could significantly improve diabetes care management.”
The analysis of self‐ or parent‐reported data from 1095 children (age 10–17 years) with type 1 diabetes who were participating in the SEARCH for Diabetes in Youth study showed that poor glycemic control, defined as a glycated hemoglobin (HbA1c) level of at least 9.5% (80 mmol/mol), was common across all methods of insulin delivery.
Specifically, the rate of poor control was 28.5% among the 694 insulin pump users, 45.2% among the 188 receiving basal–bolus injections, and 51.2% among the 213 on a mixed insulin regimen. Just 14.4%, 8.0%, and 3.8%, respectively, were within the HbA1c target of below 7.5% (58 mmol/mol).
After adjustment for sociodemographic, adherence, and barriers-to-care factors, Snyder and team found that parent-reported diabetes-related family conflict, as measured using the revised Diabetes Family Conflict Scale, was the only factor significantly associated with poor glycemic control in all three insulin regimen groups: each 1-point increase in the parent-reported family conflict score above the minimum score of 19 was associated with a 10% increased likelihood for poor glycemic control among both insulin pump users and those on a mixed insulin regimen, and a 20% increased likelihood among participants using basal–bolus injections.
Other factors significantly associated with poor glycemic control among insulin pump users were low insulin adherence (odds ratio [OR]=4.0 for missing insulin 1–5 times/week vs less than once/week), non‐White race (OR=2.7), having Medicaid insurance (OR=2.0), and living in multiple households (OR=1.8).
Living in multiple households was also a risk factor for poor control among the children on a mixed insulin regimen (OR=4.8), along with not spending enough time with a healthcare provider (OR=3.8).
None of the variables measured significantly correlated with an increased risk for poor glycemic control among basal–bolus injection users, but parental fear of hypoglycemia was associated with a decreased risk (OR=0.93 per unit increase on the low blood sugar survey). Such fear was also associated with a decreased risk among insulin pump users (OR=0.97 per unit increase).
Writing in Diabetic Medicine, Snyder and co-authors conclude that their study “demonstrates that a combination of sociodemographic, adherence and barriers-to-care factors are significantly related to glycaemic control and that these factors vary within insulin regimens.”
They continue: “Addressing these factors within insulin regimens may improve care for children with Type 1 diabetes.”
By Laura Cowen
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