Sociodemographic determinants of glycaemic control among children with type 1 diabetes in South Eastern Nigeria

Association between eHealth literacy, diabetic behavior rating, and burden among caregivers of children with type 1 diabetes: Cross-sectional survey study

OBJECTIVE

The purpose of this study was to clarify the relationship between eHealth literacy, diabetic behavior rating, and caregiving burden among caregivers of children with type 1 diabetes mellitus (T1DM).

METHODS

A questionnaire-based cross-sectional study of 143 primary caregivers of T1DM was conducted. Electronic health literacy was quantified using the Chinese version of the eHealth Literacy Scale (eHEALS). Their diabetic management behavior rating and caregiving burden were measured by Diabetes Behavior Rating Scale-Parent Version (DBRS-P) and Zarit Burden Interview (ZBI), respectively. Pearson correlation analysis was used to estimate the relationship between the above variables.

RESULTS

Only 54 (37.76%) caregivers qualified by eHEALS scale, with a total score of 30.07 ± 4.54 out of 40. A positive correlation between DRBS-P scores and the scores of eHEALS (Pearson correlation coefficient r = 0.226, P = 0.007) and a negative correlation between ZBI and eHEALS scores (r = -0.166, P = 0.047) were observed.

CONCLUSIONS

The eHealth literacy level of caregivers of children with T1DM in China remains to be improved. Caregivers with higher eHealth literacy had better diabetic management behaviors and less caregiving burden.

IMPLICATIONS TO PRACTICE

This study suggests that hierarchical electronic health-based interventions should be designed according to the different levels of eHealth literacy of individuals, to enhance the ability of caregivers with different eHealth literacy levels to fully utilize eHealth resources to improve their daily disease management skills and reduce their burden when caring for T1DM children. In addition, improving eHealth literacy of caregivers for children with T1DM can be one of the important ways to enhance the effectiveness of electronic health-based programs designed for them.

The effect of problem-solving skills on blood glucose regulation and disease management in children with type 1 diabetes mellitus

OBJECTIVES

This cross-sectional study examined the relationship between problem-solving skills, glucose regulation, and disease management in children with type 1 diabetes mellitus (T1DM) as well as the role of depression in this association.

METHODS

The participants (n=54) were recruited from a diabetes camp. Problem-solving inventory (PSI), Beck depression inventory (BDI), and diabetes self-management profile (DSMP) were administered as tests. Forty-six participants who have been diagnosed with T1DM for at least a year and completed the survey were included in the analyses. Participants were categorized into high and low depression groups based on the median split. Student's t-test was used to detect demographic differences in groups. Linear regression models were used to examine the association between PSI, HbA1c, and DSMP. Regressions for PSI and DSMP were repeated in low and high-depression groups.

RESULTS

Of the 46 participants with T1DM, 52 % were female, with a mean age of 13.96 ± 1.94 (range 10-17). Avoidant and monitoring style of problem solving as well as the total score of PSI significantly predicted HbA1c levels. Impulsive and avoidant style of problem solving, problem-solving confidence, and total scores of PSI significantly predicted DSMP (p<0.05). The high depression group had a significantly higher DSMP score than the low depression group (p=0.001), with no difference in HbA1c levels (p=0.968). When the DSMP regressions were repeated, no significant associations were seen in the low depression group. Avoidant style of problem solving, problem-solving confidence, and the total score of PSI significantly predicted DSMP in the high depression group (p<0.005).

CONCLUSIONS

Problem solving-skills are essential in children with T1DM for a successful disease management. Depression modulates the association between the problem-solving and self-management profile.

Glycemic Control and Associated Factors Among Children and Adolescents with Type 1 Diabetes Mellitus, Southwest Ethiopia

Purpose

Type 1 diabetes mellitus is the most common endocrine disorder among children and adolescents worldwide. Glycemic control is the ultimate goal of management of diabetes. Poor glycemic control is shown to be associated with complications of diabetes. Only a few studies have addressed the problem in Ethiopia, and this study aimed to determine the level of glycemic control and factors associated among children and adolescents with type 1 diabetes mellitus on follow up.

Methods

Institution based cross sectional study design was conducted on a total of 158 children and adolescents with type 1 diabetes on follow up at Jimma Medical Center from July to October 2022. Data were collected using structured questionnaire and entered into Epi Data 3.1 then exported to SPSS for analysis. Glycemic control was assessed based on glycosylated hemoglobin (HbA1c) level. Descriptive and inferential statistics were employed, and a p-value <0.05 was considered to declare statistical significance.

Results

The mean glycosylated hemoglobin of the participants was 9.67 ± 2.28%. Of the total study participants, 121 (76.6%) had poor glycemic control. In multivariable logistic regression, guardian or father as a primary caregiver [guardian (AOR=4.45, 95%, p=0.045), father (AOR=6.02, 95%, p=0.023)], minimal involvement of caregiver in insulin injection (AOR=5.39, 95%, p=0.002), poor blood glucose monitoring adherence (AOR=4.42, 95%, p=0.026), faced problems at health facility (AOR=4.42, 95%, p=0.018) and being admitted to hospital in the past 6 months (AOR=7.94, 95%, p=0.004) were the variables significantly associated with poor glycemic control.

Conclusion

Majority of children and adolescents with diabetes had poor glycemic control. Whereas, primary caregiver other than mother, minimal involvement of caregiver in insulin injection, and poor adherence to glucose monitoring were among the contributing factors for poor glycemic control. Therefore, adherence counseling and the participation of caregivers in diabetes management is recommended.

Comparison of regular with NPH insulin vs. premix insulin in children and adolescents with type 1 diabetes in a resources-limited setting: a retrospective data analysis

OBJECTIVES

Few studies addressed the efficacy of human insulin regimens (mostly premix insulin) used in many low-and-middle income countries on glycemic control of children and adolescents with diabetes. The aim of this study was to assess the efficacy of the premix insulin on the glycated hemoglobin (HbA_1c) in comparison to the regular with NPH insulin scheme.

METHODS

A retrospective study was carried out from January 2020 to September 2022 on patients with type 1 diabetes aged below 18 years followed in Burkina Life For A Child program. They were categorized into three groups, on regular with NPH insulin (Group A), on premix insulin (Group B) and on regular with premix insulin (Group C). Outcome was analyzed based on HbA_1c level.

RESULTS

Sixty-eight patients with a mean age of 15.38 ± 2.26 years and the sex ratio (M/W) 0.94 were studied. There were 14 in Group A, 20 in Group B, and 34 patients in Group C. The mean HbA_1c value in the corresponding insulin regimen was 12.8 ± 1.39%, 9.87 ± 2.18%, and 10.66 ± 2.1%, respectively. Glycemic control was better in Groups B and C than Group A (p<0.05) but there was no difference between groups B and C.

CONCLUSIONS

Our results indicate that the use of premix insulin gives a better glycemic control than NPH insulin. However, further prospective study of these insulin regimens with a strengthening education strategy and glycemic control by continuous glucose monitoring and HbA_1c is required to corroborate these preliminary findings.

Children and adolescents with type 1 diabetes mellitus in Nigeria: clinical characteristics and compliance with care

OBJECTIVES

The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM.

METHODS

This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria.

RESULTS

The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father's (p=0.001) and mother's educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother's educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother's level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5-11.6, p=0.007).

CONCLUSIONS

The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines.

Glycemic control among children with type 1 diabetes mellitus and its determinants in a resource-limited setting

OBJECTIVES

Glycemic control is an important parameter that can predict long-term complications of diabetes mellitus. It can be affected by many factors. Hence, identifying those factors for improving disease outcomes is essential. The purpose of this study was to assess glycemic control in children who were treated with a conventional insulin regimen and to identify its associated factors.

METHODS

A retrospective cohort study was conducted among children with type one diabetes mellitus (T1DM) who had follow-up from November 2015 to November 2020 at the pediatric endocrinology clinic of St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Glycemic control was assessed by measuring glycosylated hemoglobin (HbA_1C) and children who had HbA_1C within three to six months of the data collection were recruited.

RESULTS

A total of 106 children with TIDM who were on conventional insulin therapy were included in this study. Their median age at diagnosis was nine years, 47.2% were females, and 57.5% were from urban areas. The average HbA_1c of the children was 9.7%. The majority (85.2%) of the children had poor glycemic control (>7.5%). Younger age, longer disease duration, and urban residence were found to be significant predictors of good glycemic control.

CONCLUSIONS

A significant majority of children with T1DM had poor glycemic control. This calls for the need to create access to intensive diabetes care by health authorities and stakeholders to prevent the long-term complications of T1DM.