Maternal Parenting Styles and Glycemic Control in Children with Type 1 Diabetes

The Role of Systemic Family Psychotherapy in Glycemic Control for Children with Type 1 Diabetes

(1) Background: Family factors play an important role in the management of diabetes, establishing a relationship between conflicts and non-adherence to therapy. High values of HbA1c are involved in specific complications of the disease (retinopathy, nephropathy, neuropathy, ketoacidosis). This study aimed to determine the role of systemic family psychotherapeutic interventions in increasing the quality of parent-child/adolescent relationships and in optimizing the child's glycemic control. (2) Methods: In this prospective observational study, 64 parents of children and adolescents with type 1 diabetes were evaluated regarding their relationship with their children, using the Child-Parent Relationship Scale-Short Form (CPRS-short form). The children were divided into three groups: one participated for 6 months in systemic family psychotherapy with children and their parents (FT), the second group participated in individual psychotherapy (IT), and the control group (CG) received no intervention. HbA1c values were recorded before and after the interventions. (3) Results: HbA1c means decreased significantly after the family psychotherapy program. The scores on closeness in the family therapy group increased significantly, and the scores on conflict decreased significantly after the intervention, compared with IT and CG. (4) Conclusions: Systemic family psychotherapy produces better results in disease management and in strengthening parent-child relationships.

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.

Controle Materno e Autocuidado de Crianças com Diabetes Tipo 1

Introdução: O autocuidado em crianças portadoras de doenças crônicas pode ser promovido ou prejudicado pelo comportamento parental. O objetivo deste estudo foi analisar as relações entre as práticas maternas de controle (suporte apropriado vs. controle psicológico) e o autocuidado em crianças com diabetes mellitus tipo 1 (DM1). Método: Participaram 23 mães de crianças portadoras de DM1, que responderam a uma entrevista semiestruturada sobre práticas de controle materno e ao Questionário da Rotina Pediátrica do Diabetes, que avaliou o autocuidado das crianças. Resultados: o suporte apropriado da mãe, especialmente quando expresso em explicações, encorajamento e afeto positivo, foi um preditor efetivo do autocuidado infantil. Discussão: o suporte apropriado favorece a conquista de autonomia por parte da criança, que se torna progressivamente mais capaz de cuidar da própria saúde. Conclusões: programas de intervenção para crianças portadoras de DM1 e suas famílias devem promover práticas de suporte apropriado nos pais.

Adherence to the Mediterranean Diet Is Associated with Better Metabolic Features in Youths with Type 1 Diabetes

Our aim was to evaluate adherence to the Mediterranean diet (MedDiet) among children and adolescents with type 1 diabetes (T1D) in relation to metabolic control. Adherence to the MedDiet was assessed with the Mediterranean Diet Quality Index (KIDMED) questionnaire and physical activity by the International Physical Activity Questionnaire for Adolescent (IPAQ-A) on 65 subjects (32 males, 9–18 years) with T1D. Clinical and metabolic evaluation was performed (standardized body mass index (BMI-SDS), hemoglobin A1C (HbA1c), continuous glucose monitoring metrics when present, blood pressure, lipid profile). Parental characteristics (age, body mass index (BMI), socio-economic status) were reported. The adherence to the MedDiet was poor in 12.3%, average in 58.6%, and high in 29.1% of the subjects. Furthermore, 23.4% of patients were overweight/obese. The most impacting factors on BMI-SDS were skipping breakfast and their father’s BMI. HbA1c and time in range % were positively associated with sweets and fish intake, respectively. Additionally, the father’s socio-economic status (SES) and mother’s age were associated with glucose control. Blood pressure was associated with travelling to school in vehicles, extra-virgin olive oil intake and milk/dairy consumption at breakfast. The promotion of the MedDiet, mainly having a healthy breakfast, is a good strategy to include in the management of T1D to improve glucose and metabolic control. This research is valuable for parents to obtain the best results for their children with T1D.

The effectiveness of self-compassion based training program on resilience of mothers of children with type 1 diabetes in Isfahan, Iran

Background:

Concerns about the complications of diabetes and the responsibility of constantly managing a child's blood glucose are stressful for parents, especially for mothers, and can reduce their resilience. This study aimed to investigate the effectiveness of a self-compassion-based training program on the resilience of mothers of children with type 1 diabetes.

Materials and Methods:

This is a randomized clinical trial study. The statistical population of the study consisted of all mothers of children with type 1 diabetes who were being treated at the Isfahan Endocrine and Metabolism Research Centre, Iran. The study samples were recruited conveniently, 64 of whom were randomly divided into two groups (compassion training program = 32; control group = 32). The intervention group participated in eight training sessions. Data were analyzed using t-test, and Analysis of Covariance (ANCOVA) tests for between-group comparisons of dependent variables.

Results:

There was no significant difference between the mean scores of resilience before intervention (p > 0.05). Mean scores of resilience in the intervention group were significantly higher than the control group immediately (F_1,60 = 9.726 p = 0.003) and 1 month after intervention (F_{1, 60} = 13.146, p = 0.001).

Conclusions:

It may be worthwhile to suggest compassion-based training program for mothers of children with type 1 diabetes to improve their resilience.

Fear of hypoglycemia in Italian mothers of children with type 1 diabetes: the mediating role of resilience

Objective

Fear of hypoglycemia for children with diabetes influences parental life and could increase parental stress. The present study aimed to explore the association between resilience, the self-perception of the parental role, and fear of hypoglycemia in mothers of children with type I diabetes (T1DM).

Methods

Ninety mothers (mean age: 44.20 years) of children with a T1DM diagnosis (mean age: 11.48 years) were recruited from an association for parents and completed an online self-report questionnaire packet that includes: Fear of Hypoglycemia Survey, Self-Perception of the Parental Role and Resilience Scale for Adults. Participants were recruited in 2017. Data collection lasted 10 months. Data analysis was performed using the SPSS statistical package, version 22, and the PROCESS macro program by Hayes.

Results

The analysis of the mediation model shows that resilience assumes a mediational role in the relationships between the parental role and preoccupation with hypoglycemia. In particular, the mother's perceived competence and role balance can influence the development and increase of the mother's resilience, which in turn can allow a decrease in the mother's worry about the possible hypoglycemic episode of her child.

Conclusion

The findings suggest that resilience is a significant topic to focus on in interventions designed to increase the self-perception of the parental role and reduce fear of hypoglycemia in mothers.

Mothers and Fathers Parenting Stress and Their Perception of Children's Psychosocial Functioning in Paediatric Diabetes: A Pilot Study

(1) Background: In the context of a child with Type 1 Diabetes Mellitus (T1DM), the rearrangement of the family’s lifestyle can account for an increased risk of experiencing psychosocial problems for both child and parents. Those few studies on pediatric diabetes, which focused on parents’ perception of children’s psychological strengths and weaknesses, reported significantly higher rates of children’s emotional and conduct problems associated with an imbalance in the Hemoglobin A1c (HbA1c). The main aim of this paper was to assess the role of parental perception of children’s psychosocial symptoms as a mediator of the perceived parenting stress, considering mother and father separately. (2) Methods: The study involved 12 parent couples (Mothers M_age = 40.25, SD = 6.58; Fathers M_age = 42.5, SD = 6.38) of children with T1DM aged between 7 and 11 years (M_age = 8.8, SD = 0.996). Parents completed questionnaires such as the Strengths and Difficulties Questionnaire for parents and their perspective of their child, and the Parenting Stress Index–Short Form. (3) Results: Mothers and fathers had significant differences in the perception of their child’s internalizing symptoms. Specifically, mothers present a greater perception of the mentioned symptoms compared to fathers. Mediation models showed that only for fathers’ perception of the child conduct problems has a significant role between the fathers’ perception of dysfunctional interaction with the child and the HbA1c. (4) Conclusions: The current study provides useful evidence also for clinical settings, suggesting that an interesting interplay between parenting stress, perception of children’s symptoms and glucometabolic control should be taken into consideration.

Uncontrolled diabetes: A difficult mother or a mother in difficulty?

Young children with diabetes (YCD) are a particularly vulnerable group because they are reliant on adult carers in their management. Diabetes treating teams (DTT) have a responsibility towards YCD targeting good glycemic control (GC) to improve quality of life and reduce risk of complications. It can be difficult, however, in occasions to balance between providing support for struggling families and considering safeguarding YCD who are not well looked after by carers in their management. We report a 6-year-old girl with type 1 diabetes with HbA1c ranged between 10.7% and 15.7%. A number of social factors have influenced her diabetes control including parental separation, maternal mental health concerns and lack of family support. Each time, these issues have been addressed, and also when grandparents were involved, a transient short-lived improvement in GC was observed. However, there were always ongoing concerns about mother's lack of engagement with the DTT. Similar cases continue to pose significant challenges for DTT, worldwide. A balance should be kept between providing adequate support for such families against a possible need for safeguarding YCD. Using a patient centered approach, if there is no improvement in GC despite taking all measures to support mothers or families who struggle with their YCD management, it becomes difficult to justify not involving the safeguarding team and social services.