A determination of the quality of life of children and adolescents with type 1 diabetes and their parents

Humanistic burden of pediatric type 1 diabetes on children and informal caregivers: systematic literature reviews

BACKGROUND

Diagnosis of children with type 1 diabetes (T1D) imposes an unprecedented burden on children and their caregivers.

OBJECTIVE

To assess the burden of T1D on children and their informal caregivers, both after a recent diagnosis or after a longer duration of disease.

METHODS

A series of systematic literature reviews were performed to explore the burden of T1D on children with the disease and their primary informal caregivers, based on the time of diagnosis. After the extraction of the qualitative and quantitative data from the included studies, two literature-based conceptual frameworks were developed: on the burden of pediatric T1D on children, and on informal caregivers. A third conceptual framework on the shared burden of pediatric T1D on both children and informal caregivers as part of the same family unit was also developed.

RESULTS

The review of literature has identified a series of factors that affect the quality of life of children with T1D and their informal caregivers, with a direct impact on physical, emotional, and social outcomes. Generally, female patients and older adolescents experience more worry and stress that affects their quality of life. Other categories of factors affecting the child's and caregiver's burden include social, emotional, and physical factors, treatment-related and disease-related factors, as well as their coping abilities. Anxiety, depression, stress, and worry were commonly found among children and caregivers, starting with the diagnosis of T1D and continuing over time in relation to new challenges pertaining to aging or the disease duration.

CONCLUSION

T1D causes a significant burden to affected children and their caregivers, both independently and through transactional interaction within the family unit. Disease burden can be reduced by strengthening individuals for the benefit of the whole family.

Quality of Life Among Children With Type 1 Diabetes Mellitus in Alahsa: A Cross-Sectional Study

BACKGROUND

Diabetes mellitus (DM) is the most common endocrine disease in children, and its annual prevalence is increasing worldwide. Health-related quality of life (HRQoL) is a crucial indicator of chronic illnesses such as DM. This study aimed to assess the HRQoL and determine the associated factors among children and adolescents with type 1 DM in Alahsa region in 2022.

METHODS

An analytical cross-sectional study was conducted in the DiabeterSA center using the Arabic version of the Pediatric Quality of Life Inventory (PedsQl 3.2). All patients aged 5-16 years and diagnosed with type 1 DM were included in the study. Face-to-face interviews were conducted during the patients' routine visits to the outpatient clinic from September 2022 to January 2023.

RESULT

A total of 254 children aged 5-16 years (mean age: 10.87 ± 2.89 years) were recruited. The mean HRQoL total score reported by the children and adolescents was 72.61 ± 15.36. Older age, higher family socioeconomic status, excellent school performance, and higher parental education level, particularly in mothers, were significantly associated with higher total HRQoL scores. In the regression analysis, male sex (β = -0.157,P = 0.018), older age (β = 0.246, P <0.001), and excellent school performance (β = -0.290, P < 0.001) were identified as independent predictors of the HRQoL total score. Nearly 19% of the participants achieved glycemic control.

CONCLUSION

The quality of life of children and adolescents with type 1 DM in Alahsa region was relatively good. Increased age, good family economic status, and higher parent education levels positively influenced the participants' quality of life. Therefore, regular evaluation of HRQoL is recommended for children and adolescents with type 1 DM to identify problems and initiate an appropriate intervention for improving child health and the health care system.

Health-Related Quality-of-Life and Associated Factors Among Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Background

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases during childhood and adolescence. It threatens the health and endangers life with consequences for the physical and emotional development of the child and adolescent. Our study aimed at determining the health-related quality-of-life (HRQoL) and factors affecting it in children and adolescents with T1DM.

Methods

A hospital-based cross-sectional study was conducted among 379 randomly selected children and adolescents, 5-18 years of age, with T1DM on follow-up at endocrine clinics from 25 August to 25 September 2021. PedsQLTM 4.0 generic core scales were used to collect the data. Paired sample t-test was used to compare children's and adolescents' self-reports and caregiver's reports. Bivariable and multivariable linear regression is used to explore to identify significant predictor factors of HRQoL.

Results

Total mean score of HRQoL was 88.42±10.82 as reported by the children and adolescents and 82.17±12.65 reported by their primary caregivers. According to self-reports, age (β=-0.197, p=0.028), mothers' educational status (β=0.242, p<0.001), fathers' educational status (β=0.259, p<0.001), fathers' occupation (β=0.170, p=0.038), frequency of insulin administration (β=-0.132, p=0.007), diabetes duration (β=-0.101, p=0.050), and frequency of monitoring of blood glucose (β=0.165, p=0.006) were statistically significant predictors of HRQoL, explaining 21.6% of the variability of total HRQoL scores of children and adolescents (R2=0.216, F(21,357)=5.968, p<0.001).

Conclusion

Children and adolescents with T1DM in Ethiopia have relatively good HRQoL. Increased age, longer diabetes duration, and insulin administrations of three times per day were associated with decreased HRQoL scores. Educated parents, having an employed father, and frequent blood glucose monitoring were associated with higher HRQoL scores.

Health-Related Quality of Life and Its Associated Factors in Children and Adolescents with Type1 Diabetes, Addis Ababa, Ethiopia

Background. In the clinical management of diabetes, fixing metabolic variables is insufficient, and thus, health-related quality of life assessment is becoming an important indicator of the outcome of the treatment and detector of a problem in children and adolescents with chronic disease. Therefore the main aim of this study was to assess the Quality of life of children with type 1 diabetes in Addis Ababa, Ethiopia. Methods. A cross-sectional study design was included 229 study participants with type 1 diabetics aged between 8 and 18 years in Addis Ababa governmental hospitals. Samples were selected by a systematic sampling method and interviewed face to face. Health-related quality of life was determined by the pediatric quality of life inventory. Multivariable linear regression was done and a significant association was declared at P < .05. Result. The total mean score of health-related quality of life was 78.8 ± 15.6 reported by child and 61 ± 7.9 reported by parents. In this study well-controlled glycemic level (β = 11.8, 95%CI: 8.7, 14.9), health education on diabetes (β = 5.92, 95%CI: 2.9, 8.9) and frequency of hospital admission (β = −2.6, 95%CI: −4.8, −0.42) were clinically predicting factors of health-related quality of life. Conclusion. This study found that there was a somewhat reduction in school and emotional functions of health-related quality of life. The glycemic level, health education of diabetes and frequency of hospital admission was clinically significant factors of health-related quality of life. This study will recommend to the health professional to sustain a health education program on diabetes.

The Relationship between Glycated Hemoglobin Levels and the Quality of Life among Type 1 Diabetes Mellitus in Children

BACKGROUND: Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia that occurs due to impaired both in insulin secretion and insulin action. Children with type 1 diabetes mellitus should be targeted to achieve a glycated hemoglobin (HbA1C) level ≤7.0% to reduce the risk of complications and improve quality of life. The majority of children with type 1 diabetes mellitus exhibit poor self-care and Health-related Quality of life behavior. AIM: The objective of the study was to determine the relationship between HbA1C level and the quality of life among type 1 diabetes mellitus in children. METHODS: A cross-sectional study was conducted among 30 children with type 1 diabetes mellitus who attended at pediatric endocrine clinic Haji Adam Malik general hospital and Universitas Sumatera Utara hospital Medan. Sampling was carried out in April 2020–July 2020. HbA1C level and self-administered questionnaire were used to assess the quality of life. Spearman correlation test was conducted to assess the correlation between HbA1C levels and the quality of life. RESULTS: The mean of HbA1C level was 10.35 ± 2.68. No significant correlation between HbA1C level and the quality of life of children with type 1 diabetes mellitus (r = 0.264, p > 0.05) CONCLUSIONS: There was no significant correlation between HbA1C levels and the quality of life of children with type 1 diabetes mellitus.

Reliability and Validity of Ethiopian Amharic Version of the PedsQLTM 4.0 Generic Core Scales and PedsQLTM 3.0 Diabetes Module

BACKGROUND

The PedsQLTM 4.0 generic core scales (GCS) assess the generic health by integrating with disease-specific PedsQLTM 3.0 diabetes module (DM). The PedsQLTM 3.0 DM measures the health-related quality of life (HrQoL) specific to diabetes. Even though there is no translation to Ethiopian Amharic, the instruments had translated to different languages and validated. The study is aimed to assess the validity and reliability of the Amharic version of the PedsQLTM 4.0 GCS and the PedsQLTM 3.0 DM in children and adolescents with diabetes.

METHODS

PedsQLTM 4.0 GCS and the PedsQLTM 3.0 DM were administered on 193 children and adolescents with diabetes and their parents. The validity was examined by the exploratory factor analysis, multitrait/multi-item scaling analysis, and multitrait-multimethod and monotrait-multimethod analysis. Cronbach's alpha coefficient checked the reliability.

RESULTS

Cronbach's alpha coefficient for the total PedsQLTM 4.0 GCS (α child self-report= 0.96; α parent proxy report= 0.95) and for total PedsQLTM 3.0 DM (α child self-report= 0.96; α parent proxy report=0.93) were acceptable at individual patient-level analysis. The monotrait-multimethod correlations were higher than multitrait-multimethod correlations. In multitrait/multi-item scale analysis, both total PedsQLTM 4.0 GCS and PedsQLTM 3.0 DM had an excellent item convergent and discriminatory validity success rate.

CONCLUSION

The Amharic versions of the PedsQLTM 4.0 GCS and the PedsQLTM 3.0 DM were valid and reliable instruments to measure the HrQoL of children and adolescents with diabetes.

Influence of transition readiness from paediatric to adult health care on quality of life in child-parent dyads with long-term conditions

AIM

To delineate the impact of perspective of children's transition readiness from paediatric to adult health care on quality of life in child-parent dyads with long-term conditions. We used Actor-Partner Interdependence Model to identify actor effects (effect of one's own transition readiness on one's own quality of life) and partner effects (effect of one's own transition readiness on the partner's quality of life).

DESIGN

A multi-centre cross-sectional survey.

METHODS

The study was conducted in two paediatric hospitals in China from October 2018-August 2019. We used a researcher-designed questionnaire to collect demographic and clinical characteristics. Furthermore, we used four questionnaires assessing transition readiness and quality of life in child and parent respectively to collect data from 370 child-parent dyads. Structural equation modelling was applied to estimate the effect of actor-partner interdependence models.

RESULTS

The total score of transition readiness had two actor effects on total child and parent quality of life controlling for age (β_children  = 3.335, p = .032 and β_parents  = 8.952, p < .001), while only one actor effect controlling for gender (β_parents  = 8.891, p < .001). Specific transition readiness dimensions had different partner effects on different domains of children and parents' quality of life. Moreover, younger children and fathers had a better quality of life.

CONCLUSION

Our study verified inherently interpersonal relationship that transition readiness appeared to influence quality of life in child-parent dyads with long-term conditions.

IMPACT

This study was the first to verify mutual influence of transition readiness and quality of life in child-parent dyad using actor-partner interdependence model. Nurses who design the transition promoting programs should consider the effective communication between healthcare provider and child-parent dyads and support parents' involvement to improve shared understanding about managing child's condition, especially for older children and mothers.

Sickle cell disease in Grenada: Quality of life and barriers to care

BACKGROUND

Grenada is a small, resource-limited Caribbean country with a high incidence of sickle cell disease (SCD). Since little is known about the challenges facing individuals living with SCD in the West Indies, we sought to assess barriers to healthcare and the impact of SCD on quality of life in Grenada.

METHODS

Both adults aged 18+ (n = 19) and caregivers of children aged 2-17 (n = 26) completed validated survey measures regarding barriers to care and quality of life, along with a genetics knowledge questionnaire. Caregivers also completed a caregiver burden scale. Survey scores were calculated, and responses were analyzed for an association between demographic variables.

RESULTS

The Barriers to Care Questionnaire, in which lower scores indicate more barriers, revealed that both adults (mean = 69.9) and children (mean = 75.5) with SCD experienced reduced access to care. The Adult Sickle Cell Quality of Life Measurement Information System indicated increased depression and loneliness in adults, with the lowest scores in the Emotional subscale. However, the Pediatric Quality of Life Inventory answered by caregivers of children with SCD showed the lowest scores in the Physical Functioning subscale. Further analysis using the Caregiver Burden Scale-Zarit Burden Interview revealed that 53.8% of caregivers of children with SCD indicated "little to no burden," which may reflect a difference in cultural expectations of a caregiver between high-income countries and Grenada. Finally, ~80% of respondents knew that SCD was a genetic condition; however, 61%-84% could not correctly indicate recurrence risks, demonstrating a need for additional education.

CONCLUSION

These data provide new insights regarding the experience of living with SCD in Grenada and support the need for further investigations into specific barriers to healthcare delivery, which could also improve education and well-being for those affected by SCD in Grenada and in the broader Caribbean community.

Predicting Quality of Life among Mothers in an Online Health Community for Children with Type 1 Diabetes

Quality of life of parents of children with chronic disease is important for disease self-management. This study aimed to identify predictors of quality of life among mothers of children with type 1 diabetes. A cross-sectional study was conducted. A total of 208 mothers of children with type 1 diabetes were recruited from an online health community. Online health community collective empowerment and social support, diabetes self-efficacy, diabetes-related burden, and quality of life were measured. A multiple regression analysis was conducted to determine predictive factors for quality of life. Multiple regression analysis showed that diabetes-related burden and the child’s age were predictors of quality of life, and total variance explained by the model was 64.1% using two factors. In mothers of younger children, it is important to reduce the diabetes-related burden. Factors that increase the diabetes-related burden should be identified, and strategies to reduce the diabetes-related burden must be established.

Emotional quality-of-life and patient-reported limitation in sports participation in children with uncorrected congenital and acquired heart disease in healthcare-restricted settings in low- and middle-income countries

BACKGROUND

Little is known about emotional quality-of-life in paediatric heart disease in low- and middle-income countries where the prevalence of uncorrected lesions is high. Research on emotional quality-of-life and its predictors in these settings is key to planning interventions.

METHODS

Ten-year retrospective cross-sectional study of children aged 6-17 years with uncorrected congenital or acquired heart disease in 12 low- and middle-income countries was conducted. Emotional functioning score of the PedsQL TM 4.0 generic core scale and data on patient-reported limitation in sports participation were collected via in-person interview and analysed using regression analyses.

RESULTS

Ninety-four children reported mean emotional functioning scores of 71.94 (SD 25.32) [95% CI 66.75-77.13] with lower scores independently associated with having a parent with a chronic illness or who had died (p = 0.005), having less than three siblings (p = 0.007), and reporting a subjective limitation in carrying an item equivalent to a 4 lb load (p = 0.021). Patient-reported limitation in sports participation at least "sometimes" was present in 69% and was independently associated with experiencing symptoms at least once a month (p < 0.001).

CONCLUSION

Some of the factors which were associated with better emotional quality-of-life were similar to those identified in previous studies in patients with corrected defects. Patient-reported limitation in sports participation is common. In addition to corrective surgery and exercise, numerous other interventions which are practicable during surgical missions might improve emotional quality-of-life.