Authoritarian parenting style predicts poorer glycemic control in children with new-onset type 1 diabetes

Parental Psychosocial Variables and Glycemic Control in T1D Pediatric Age: A Systematic Review

PURPOSE OF REVIEW

This review aimed to summarize the evidence regarding the relationship between parental psychosocial (e.g., fear of hypoglycemia, stress and family conflict) and glycemic outcomes in children between the age of 1-10 years old.

RECENT FINDINGS

Type 1 Diabetes (T1D) in young children can be very complex to manage for their parents since they are the main individuals responsible for T1D tasks. Also, parental psychological adjustment impacts children's glycemic outcomes. This systematic review was performed following the PRISMA guidelines. The search process was conducted in four databases from 2019 to 2024. From a total of 215 studies, 5 were included. We identified five studies that found direct associations between parental psychosocial variables and children's glycemic outcomes. These findings suggest a unidirectional perspective, evidencing the need to examine the longitudinal interplay between these variables. In sum, promoting parental psychological interventions may be fundamental for enhancing children's glycemic outcomes.

Parenting style and child asthma control in families of school-age children with asthma: The mediating effects of children's general self-efficacy and medication adherence

PURPOSE

Parenting style plays a pivotal role in children's chronic disease control. However, the relationship and underlying mechanism between parenting style and asthma control remain unclear. This study investigated the effects of parenting style on children's general self-efficacy, medication adherence and asthma control and the mediating effects of general self-efficacy and medication adherence among school-age children with asthma.

DESIGN AND METHODS

A cross-sectional study with a convenience sampling approach was conducted. This study followed the STROBE guidelines. School-age children with asthma and their parents (N = 211) from pediatric respiratory clinics in China completed the General Questionnaire, Short-Egna Minnen av. Barndoms Uppfostran-Chinese, General Self-Efficacy Scale, Medication Adherence Questionnaire and Childhood Asthma Control Test. Structural equation modeling was used to examine the mediation models.

RESULTS

Positive parenting style was positively correlated with child general self-efficacy, medication adherence and asthma control (r = 0.602, 0.572, 0.613, p < 0.001). Negative parenting style was negatively correlated with child general self-efficacy, medication adherence and asthma control (r = -0.535, -0.598, -0.586, p < 0.001). Structure Equation Modle (SEM) results indicated that the relationships between positive parenting style, negative parenting style and child asthma control were mediated by general self-efficacy (Effect Size [ES]: 0.209, 95%CI [0.075, 0.372]; and ES: -0.229, 95%CI [-0.387, -0.103], respectively) and medication adherence (ES: 0.128, 95%CI [0.032, 0.322]; and ES: -0.190, 95%CI [-0.432, -0.071], respectively) and together in serial (ES: 0.177, 95%CI [0.076, 0.295]; and ES: -0.118, 95%CI [-0.235, -0.020], respectively).

CONCLUSIONS

Parenting style may impact child asthma through both child general self-efficacy and medication adherence. The study may provide useful intervention targets for improving asthma control.

PRACTICE IMPLICATIONS

Nurses should encourage parents to increase positive parenting style while decreasing negative parenting style. Family interventions focusing on general self-efficacy and medication adherence may be advantageous to improve asthma control.

Latent classifications of parental involvement in diabetes management for youth with type 1 diabetes: A randomized clinical trial

OBJECTIVE

Understanding how parent-child relationships influence diabetes management in youth with type 1 diabetes is critical for minimizing the risk of short- and long-term complications. We examined how classes of diabetes-specific parenting behaviors are associated with disease management and well-being for youth with type 1 diabetes.

RESEARCH DESIGN AND METHODS

The Family Management of Diabetes clinical trial tested the efficacy of a 2-year behavioral intervention for families of youth with type 1 diabetes. Three hundred and ninety youth diagnosed with type 1 diabetes and their primary caregiver were recruited from four pediatric endocrinology centers in the US Classifications of parental involvement utilized baseline parent and youth reports of task involvement, collaborative involvement, and parent-youth conflict. Class differences in baseline glycemic control (HbA1c), regimen adherence, general and diabetes quality of life, and depressive symptoms, and 2-year change in HbA1c were examined.

RESULTS

Latent profile analysis identified three classes: (1) high in task and collaborative involvement, low in conflict (Harmonious), (2) low in task involvement, collaborative involvement, and conflict (Indifferent), (3) high in task involvement and conflict, low in collaborative involvement (Inharmonious). The Harmonious group demonstrated the best adherence, glycemic control, and psychosocial well-being. The Inharmonious and Indifferent groups had similar diabetes management, but youth from Inharmonious families showed poorer psychosocial well-being. The intervention effect on glycemic control did not differ across the classes.

CONCLUSIONS

The interplay of parental involvement and conflict resulted in distinct parenting classes that differed in disease management and well-being. However, the classes benefitted similarly from the behavioral intervention.

Assessment of Bone Mineral Density in Type 2 Diabetes: A Cone Beam Computed Tomography (CBCT) Study

Introduction

The main purpose of the study was to assess and compare bone mineral density (BMD) at prospective implant sites in the mandible in type 2 diabetes mellitus (T2DM) and non-diabetic patients using cone beam computed tomography (CBCT).

Material and methodology

A total of 40 patients were included in this type of cross-sectional study. They were divided into two groups, A and B, according to their haemoglobin A1c values. Group A consisted of patients with HbA1c between the range of 6.1%-8% and group B had patients with no history of T2DM. CBCT scans were made of the mandibular arches of both the patients to evaluate the BMD at lingual and buccal cortical plates and the trabecular regions in two successive slices with the assistance of PlanMeca Romexis software (PlanMeca Romexis®, Helsinki, Finland). The Shapiro-Wilk test was used to determine the normality of continuous data. The Mann-Whitney U test was used to compare the groups.

Results

There were no differences that were statistically significant between the two cohorts according to the Mann-Whitney U test at buccal cortical plate points 1 and 2. However, the diabetes group's mean bone density at implant sites-A, B, C, D, and E at trabeculae points 1 and 2 was considerably (7p>0.001) lower than the non-diabetic groups. The mean bone density of the diabetes group was marginally but significantly (p=0.009) lower than the non-diabetic group at lingual cortical plates.

Conclusion

Individuals with type 2 diabetes mellitus show significantly lower bone mineral density in the lingual cortical plate and trabecular region, however, implant therapy can be performed with certain mentioned guidelines in such regions. In the buccal cortical region, the bone mineral density is seen to be unaffected.

Continuous Glucose Monitoring Decreases Hypoglycemia Avoidance Behaviors, but Not Worry in Parents of Youth With New Onset Type 1 Diabetes

BACKGROUND

Existing research shows that hypoglycemia fear (HF) is common in parents of children with established type 1 diabetes (T1D). We examined parental HF in the T1D recent-onset period and evaluated whether continuous glucose monitoring (CGM) adoption relates to improved outcomes of parental HF.

METHODS

In TACKLE-T1D, a prospective study of five- to nine-year olds with recent-onset T1D, parents completed the Hypoglycemia Fear Survey-Parents (HFS-P) at baseline (T1) and 6 (T2) and 12 (T3) months post-baseline. The HFS-P measures worry about hypoglycemia (HFS-Worry score) as well as hypoglycemia avoidance behaviors (HFS-Behavior score). We recorded CGM start dates for youth during the same time period through medical record review.

RESULTS

Between T1 and T2, 31 youth (32.3%) initiated CGM therapy, and between T2 and T3, an additional 17 youth (17.7%) began using CGM, leaving 48 youth who never initiated CGM therapy (50%) in the recent-onset period. Parents reported moderate HFS-Worry scores at T1 (32.9 ± 11.9), which increased between T1 and T2 (37.6 ± 11.4, P < .001) and plateaued between T2 and T3 (37.7 ± 12.4, P = .89). In contrast, parental HFS-Behavior scores decreased between T1 (33.1 ± 5.8) and T2 (32.2 ± 6.0, P = .005) and plateaued between T2 and T3 (32.2 ± 6.0, P = .95). Baseline HFS-Behavior and Worry scores were associated with increased adoption of CGM between T1-T2 and T2-T3, respectively. Parents of children initiating CGM therapy between T1 and T2 showed the largest decrease in HFS-Behavior (P = .03).

CONCLUSIONS

Initiating CGM therapy within the first 12 months of T1D may help reduce parents' use of hypoglycemia avoidance behaviors, but has little effect on parents' hypoglycemia worry.

Parents' experience of caring for children with type 1 diabetes in mainland China: A qualitative study

BACKGROUND

Parents of children with type 1 diabetes mellitus (T1DM) are under heavy caregiving stress, and parental caregivers' experience can affect the health outcomes of children with T1DM.

AIM

To describe the true inner feelings of parents caring for children with T1DM.

METHODS

Descriptive research methods were used to classify and summarize parents' experience when adapting to the role of caregivers for children with T1DM. The data was sorted and analyzed using content analysis. Themes of parents' experience caring for children with T1DM were refined, and their feelings were deeply investigated.

RESULTS

A total of 4 themes and 12 subthemes were identified: (1) Desire for information (disease-related information, home care information, and channels of information acquisition); (2) Skill guidance needs (insulin injection techniques, skills required for symptom management, and skills for parent-child communication); (3) Seeking emotional support (family support, peer support from other parents of children with T1DM, and professional support); and (4) Lack of social support (needs for financial support and needs for social security).

CONCLUSION

Exploring the true experience of parents caring for children with T1DM is of great significance for helping them adapt to their role as caregivers. Nurses should provide professional guidance in terms of information, skills, emotion, and social support to parental caregivers.

Comparison of Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections in Pediatric Type 1 Diabetes: A Meta-Analysis and Prospective Cohort Study

BACKGROUND

The incidence of pediatric type 1 diabetes (T1D) is increasing worldwide, and the appropriate choice of therapy regimens is important for children, especially in developing countries with inadequate resources.

METHODS

We conducted a design combining meta-analysis and prospective cohort study. In meta-analysis, 14 studies involving 69,085 TID cases reported glycosylated hemoglobin (HbA_1c) levels, including 48,363 multiple daily insulin injections therapy (MIT) and 20,722 continuous subcutaneous insulin infusion (CSII). In our prospective cohort study, TID cases were recruited from a tertiary children's hospital, and randomly divided into Group MIT and Group CSII. After the 4-year follow-up, the effects of MDI (n = 112) and CSII (n = 76) therapy on glycemic control, long-term complications, as well as the growth and pubertal development were explored.

RESULTS

Compared to CSII in TID, HbA_1c levels in MDI (WMD = 0.21, 95% CI: 0.20 to 0.23) were increased significantly in meta-analysis. Among 188 clinical cases, mean age at recruitment was 7.55 (SD 2.91) years. Duration of TID was 4.23 (SD 2.61) years. 50.53% (n = 95) of them were boys. The 4-year follow-up showed that children's HbA_1c was 0.67 (95% CI -1.28, -0.05) % lower in children with CSII compared to children with MDI in multivariable regression models with adjustment for potential confounders (children's age at follow-up, duration of TID, gender, birthweight, parity, and delivery method). CSII was associated with 2.31 kg higher in children's weight (95% CI 0.59, 4.04) in the adjusted model. No difference was found in peripheral nerve and fundus consequences as well as the status of obesity and thin and pubertal development between CSII and MIT.

CONCLUSION

CSII might be associated with better glycemic control and better effect for children growth development. No higher risks of long-term complications and delayed pubertal development were observed in CSII. Our findings provided evidence for a better therapy regimen for T1D in children, nevertheless, they need to be validated by a larger sample size study.

Family and household structure are associated with acute type 1 diabetes complications: results of cross-sectional analyses

AIM

To examine the association of family/household structure with short-term diabetes complications in adolescents and emerging adults with early-onset type 1 diabetes in more detail.

METHODS

Data on 1690 11-21-year-olds with type 1 diabetes were used to estimate associations of family/household structure with self-reported severe hypoglycaemia, hospitalizations for severe hypoglycaemia or diabetic ketoacidosis, applying multiple negative binomial regression.

RESULTS

Compared with living with both biological parents living with a single mother was associated with an increased rate of hospitalizations for ketoacidosis (incidence rate ratio 1.71, 95% CI 1.00-2.82). Incidence rate ratio of hospitalizations for ketoacidosis was similar (1.67, 95% CI 0.91-3.07) if the mother lived with a partner, however, hypoglycaemia-related hospitalizations increased (3.66, 95% CI 1.54-8.71). Participants living with a single father had 4.43 (95% CI 1.30-15.05) /10.42 (95% CI 1.55-70.22) times higher rates of severe hypoglycaemia and related hospitalizations, while living with a father and his partner was associated with an increased incidence rate ratio of hospitalizations for ketoacidosis (3.48, 95% CI 0.96-12.63) compared with living with both biological parents.

CONCLUSIONS

Findings of our exploratory analyses point to different self-reported diabetes outcomes depending on the family/household structure. If confirmed in future studies, they may help to identify young people with diabetes at risk of short-term diabetes complications.

Stressful life events, parental psychosocial factors, and glycemic management in school-aged children during the 1 year follow-up of new-onset type 1 diabetes

OBJECTIVE

To monitor occurrence of stressful life events, assess correlations with family functioning and parental psychosocial measures, and examine the impact of stressful life events on diabetes management in the first year after diagnosis of type 1 diabetes (T1D) in children using a mixed methods design.

METHODS

In a prospective study of 5- to 9-year-olds with recent-onset T1D (mean age 7.4 ± 1.3 years, T1D duration 4.7 ± 3.3 months), we monitored glycated hemoglobin A1c (HbA1c), income, job status, family health, and marital status at baseline and every 3 months up to 1 year. We measured coping, parental depression, and diabetes family conflict at baseline.

RESULTS

Of 128 families, 53.9% (n = 69) reported 1+ stressful event, with 25.8% reporting income change (n = 33) during this period, 23.4% additional family health changes (n = 30), 22.7% job changes (n = 29), 21.9% changes in child's school (n = 28), and 3.9% changes in marital status (n = 5). Baseline active avoidance coping, parental depression, and diabetes family conflict correlated with a higher number of stressful life events (r = 0.239, P < .01; r = 0.197, P < .05; r = 0.225, P < .01, respectively). There were also cross-sectional associations between HbA1c and income decrease, school change, and job change at various time points in the study.

CONCLUSIONS

Families can experience concurrent life stressors during the first year of T1D, which relate to coping, depression, and conflict. Consistent with existing literature, stressful life events relate to glycemic management. Future research should explore the individual's or parent's perception of stress and ways that diabetes centers can effectively assist families of youth with T1D and concurrent life stressors.