Greta Friedemann-Sánchez1, Beatrix D Capistrant2,3, James Ron4,5, Lindsey Novak6, Caroline Zuijdwijk7, Graham D Ogle8, Barbara Anderson9, Antoinette Moran10, Sharad Pendsey11. 1. Hubert H. Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota. 2. School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota. 3. Statistics and Data Science, Smith College, Northampton, Massachusetts. 4. Hubert H. Humphrey School of Public Affairs and Department of Political Science, University of Minnesota, Minneapolis, Minnesota. 5. Centro de Investigación y Docencia Económicas (CIDE), Mexico City, Mexico. 6. Department of Economics, Colby College, Waterville, Maine. 7. Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, Ottawa, Canada. 8. International Diabetes Federation, Life for a Child Program, Glebe, Australia. 9. Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas. 10. Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. 11. Diabetes Research Education and Management Trust, Nagpur, India.
Abstract
AIMS: Parental care influences outcomes for children's type 1 diabetes (T1D). There is little evidence about the impact of parental caregiving in developing countries, where fixed dose human insulin (conventional) therapy and limited self-monitoring of blood glucose are common. This article investigates whether performance of key T1D management tasks by children or their caregivers impacts hemoglobin A1c (HbA1c). METHODS: We surveyed the caregivers of 179 children with T1D routinely treated in a specialized diabetes clinic in Maharashtra, India to determine who performs key diabetes care tasks: child or parent. We used linear regression to estimate the relationship between parental caregiving and HbA1c, and how this association varies by child age and time since diagnosis. RESULTS: Caregivers of older children were less involved in care tasks, though caregivers of 11- to 18-year olds performed more care for children diagnosed for a longer duration. Parental involvement in key insulin delivery tasks was associated with lower HbA1c levels for all children. These reductions were greatest among children 11 to 14 years old and diagnosed for less than 2 years: mean HbA1c levels were 8.5% (69 mmol/mol) if the caregiver, and 14.4% (134 mmol/mol) if the child, performed the tasks (P < .05). CONCLUSION: Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.
AIMS: Parental care influences outcomes for children's type 1 diabetes (T1D). There is little evidence about the impact of parental caregiving in developing countries, where fixed dose human insulin (conventional) therapy and limited self-monitoring of blood glucose are common. This article investigates whether performance of key T1D management tasks by children or their caregivers impacts hemoglobin A1c (HbA1c). METHODS: We surveyed the caregivers of 179 children with T1D routinely treated in a specialized diabetes clinic in Maharashtra, India to determine who performs key diabetes care tasks: child or parent. We used linear regression to estimate the relationship between parental caregiving and HbA1c, and how this association varies by child age and time since diagnosis. RESULTS: Caregivers of older children were less involved in care tasks, though caregivers of 11- to 18-year olds performed more care for children diagnosed for a longer duration. Parental involvement in key insulin delivery tasks was associated with lower HbA1c levels for all children. These reductions were greatest among children 11 to 14 years old and diagnosed for less than 2 years: mean HbA1c levels were 8.5% (69 mmol/mol) if the caregiver, and 14.4% (134 mmol/mol) if the child, performed the tasks (P < .05). CONCLUSION: Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.