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Pironetti R, Saha M, Luukkaala T, Keskinen P. Sociodemographic factors affecting glycaemic control in Finnish paediatric patients with type 1 diabetes. Endocrinol Diabetes Metab 2023; 6:e452. [PMID: 37749959 PMCID: PMC10638615 DOI: 10.1002/edm2.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023] Open
Abstract
AIMS Socioeconomic problems may present significant challenges when trying to reach optimal glycaemic control in paediatric patients with type 1 diabetes. We examined sociodemographic factors affecting metabolic control in patients in one of the biggest paediatric diabetes clinics in Finland. METHODS One hundred ninety-one children (age 2-15 years; median 11 years; 47% female) with type 1 diabetes and their families were recruited during outpatient visits in the paediatric diabetes clinic of Tampere University Hospital, Finland. The participants completed a questionnaire on the family's sociodemographic background. The child's glycaemic control was assessed by both glycosylated haemoglobin (HbA1c) and time in range (TIR). Risk factors for poor (HbA1c ≥75 mmol/mol; TIR <40%) and optimal (HbA1c <53 mmol/mol; TIR ≥70%) metabolic control were searched using logistic regression analyses. RESULTS Living in a nuclear family, male gender, younger age and a school assistant for diabetes management were associated with the simultaneous presence of both indicators of optimal metabolic control. Poor glycaemic control, as estimated by HbA1c, was associated with lower parental education and the child's older age. Parental smoking and the child's older age were associated with poor TIR. CONCLUSION This study confirms the importance of sociodemographic factors in care of Finnish paediatric patients with type 1 diabetes. Sociodemographic status markers of the family could be used as triggers to alert paediatric diabetes teams to offer more tailored care to families with new-onset type 1 diabetes mellitus.
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Affiliation(s)
- Riina Pironetti
- Department of PaediatricsTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Marja‐Terttu Saha
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Tiina Luukkaala
- Research, Development and Innovation CenterTampere University HospitalTampereFinland
- Faculty of Sciences, Health SciencesTampere UniversityTampereFinland
| | - Päivi Keskinen
- Department of PaediatricsTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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da Silva AP, Araujo ACMC, Mesquita IMR, Fonseca ECR, Tomé JM, Palhares HMDC, Silva ÉMC, Borges MDF. Religious/spiritual coping, symptoms of depression, stress, and anxiety in caregivers of children and adolescents with type 1 diabetes. Fam Pract 2022; 39:1017-1023. [PMID: 35477768 DOI: 10.1093/fampra/cmac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It was verified the level of religiosity and spirituality, and symptoms of depression, stress, and anxiety of caregivers of children and adolescents with type 1 diabetes, and its interference in glycaemic control. METHODS Socio-economic and demographic data were collected from caregivers of 59 children and adolescents with type 1 diabetes and obtained dosages of fasting glucose (FG); postprandial glycaemia (PPG); fructosamine (FRUTO); and HbA1c, as well as the glycaemic variability-∆HbA1c. Levels of religiosity were obtained by the DUREL scale; the use of religious/spiritual coping was verified by the SRCOPE-Brief scale. Symptoms of depression, anxiety, and stress were analysed by the DASS-21 scale. The correlations between the variables were analysed by the Pearson coefficient, with significance at 5% level. RESULTS Inverse correlations were observed between caregivers' schooling with PPG (r = -0.30; P = 0.002) and FRUTO (r = -0.34; P = 0.008) and between family income and FRUTO (r = -0.37; P = 0.004). Direct, moderate correlations were observed between negative religious/spiritual coping (NSRCOPE) with symptoms of depression (r = 0.588; P < 0.0001), stress (r = 0.500; P < 0.0001), and anxiety (r = 0.551; P < 0.0001). CONCLUSION The direct association between NSRCOPE with symptoms of depression, stress, and anxiety was the highlighted item in the present study emphasizing the need for greater attention to the emotional health of informal caregivers of children and adolescents with DM1. It is necessary to reflect on the religious/spiritual support especially for the main caregiver of children and adolescents with DM1.
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Affiliation(s)
| | | | | | | | | | | | - Élida Mara Carneiro Silva
- Integrative and Complementary Practices Center of Clinical Hospital, Federal University of Triângulo Mineiro, Uberaba, Brazil
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Alassaf A, Gharaibeh L, Odeh R, Ibrahim S, Ajlouni K. Predictors of glycemic control in children and adolescents with type 1 diabetes at 12 months after diagnosis. Pediatr Diabetes 2022; 23:729-735. [PMID: 35393709 DOI: 10.1111/pedi.13342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/03/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
Identifying risk factors for suboptimal glycemic control during the first year after diagnosis with type 1 diabetes (T1D) may provide early appropriate and individualized management. Our aim was to study possible predictors of early glycemic control during the first year after diagnosis with T1D in children and adolescents in Jordan. This is a retrospective study conducted through a review of medical records at Jordan University Hospital and the National Centre for Diabetes, Endocrinology and Genetics. Children and adolescents diagnosed with T1D at age younger than 16 years and with diabetes duration of at least 2 years were included. Demographic, clinical and socioeconomic factors were collected, in addition to glycosylated hemoglobin (HbA1c) values during the first year after diagnosis. Average age at diagnosis of the 337 patients who were enrolled in the study was 7.7 ± 3.8 years. HbA1c at diagnosis was 10.9 ± 1.9% (95.64 ± 20.76 mmol/mol). Factors such as the involvement of children's mothers in deciding insulin doses, higher mother's educational level and higher family monthly income were associated with better early glycemic control. HbA1c at 6 months after diagnosis, parental marital status and compliance to counting carbohydrates were significant predictors of glycemic control at 12 months after diagnosis. Many clinical and socioeconomic factors were associated with early glycemic control at 12 months after diagnosis. Modifiable risk factors must be addressed as early as possible to decrease future complications. Children with nonmodifiable risk factors should be identified early for closer observation and providing individualized diabetes care plan.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman, Jordan
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Full-Time or Working Caregiver? A Health Economics Perspective on the Supply of Care for Type 1 Diabetes Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031629. [PMID: 35162654 PMCID: PMC8835134 DOI: 10.3390/ijerph19031629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic disease requiring lifelong insulin treatment. T1DM patients require care given not only by themselves but also by their family members, particularly in childhood-onset cases. This study aims to identify the relationship between health expenditure, HbA1c and other health outcomes and the socio-economic status of patients and their families, with a focus on family employment status, i.e., whether the caregiver is employed or is a homemaker. To clarify the relationship between the level of health, such as expenditure on health care and HbA1c, and the socioeconomic status of patients and their families, we focus on whether they are “potential full-time caregivers”. Using this analysis, we estimated the hypothetical health care expenditure and HbA1c and showed that male patients have higher expenditure and lower HbA1c when their caregiver is a potential full-time caregiver, whereas younger female patients have higher health care expenditure and lower HbA1c when their caregiver is employed. This finding is not meant to serve as criticism of health care policy in this area; rather, the aim is to contribute to economic policy in Japan for T1DM patients 20 years and older.
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Sutherland MW, Ma X, Reboussin BA, Mendoza JA, Bell BA, Kahkoska AR, Sauder KA, Lawrence JM, Pihoker C, Liese AD. Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes. Pediatr Diabetes 2020; 21:1412-1420. [PMID: 32902080 PMCID: PMC8054269 DOI: 10.1111/pedi.13112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Health inequities persist in youth and young adults (YYA) with type 1diabetes in achieving optimal glycemic control. The purpose of this study was to assess the contribution of multiple indicators of social need to these inequities. RESEARCH DESIGN AND METHODS Two hundred and twenty two YYA withtype 1 diabetes enrolled in the SEARCH Food Insecurity Study in South Carolina and Washington between the years 2013 and 2015 were included. Latent class analysis was used to identify socioeconomic profiles based on household income, parental education, health insurance, household food insecurity, and food assistance. Profiles were evaluated in relation to glycemic control using multivariable linear and logistic regression, with HbA1c > 9%(75 mmol/mol) defined as high-risk glycemic control. RESULTS Two profiles were identified: a lower socioeconomic profile included YYA whose parents had lower income and/or education, and were more likely to be uninsured, receive food assistance, and be food insecure. A higher socioeconomic profile included YYA whose circumstances were opposite to those in the lower socioeconomic profile. Those with a lower socioeconomic profile were more likely to have high-risk glycemic control relative to those with a higher socioeconomic profile (OR = 2.24, 95%CI = 1.16-4.33). CONCLUSIONS Lower socioeconomic profiles are associated with high-risk glycemic control among YYA with type 1 diabetes. This supports recommendations that care providers of YYA with type 1 diabetes assess individual social needs in tailoring diabetes management plans to the social context of the patient.
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Affiliation(s)
- Melanie W. Sutherland
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Xiaonan Ma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jason A. Mendoza
- Department of Pediatrics and Nutritional Sciences Program, University of Washington; Cancer Prevention Program, Fred Hutchinson Cancer Research Center; and Seattle Children’s Research Institute, Seattle, WA
| | - Bethany A. Bell
- College of Social Work, University of South Carolina, Columbia, SC
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine A. Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Mangla P, Gupta S, Chopra A, Bhatia V, Vishwakarma R, Asthana P. Influence of Socio-Economic and Cultural Factors on Type 1 Diabetes Management: Report from a Tertiary Care Multidisciplinary Diabetes Management Center in India. Indian J Pediatr 2020; 87:520-525. [PMID: 32086759 DOI: 10.1007/s12098-020-03227-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/29/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To study the association of socio-economic (SE) and cultural factors with HbA1c and diabetes knowledge of children, adolescents and young adults with T1DM managed in the authors' centre, as these may be unique to a country or a region. METHODS Demographic details, SE scoring, body mass index and mean of the last two HbA1c values were recorded, in 173 eligible patients. A diabetes knowledge test (DKT) was administered. RESULTS Median (range) age was 14.0 (3.25-25.5) y and HbA1c 8.2 ± 1.3%. The patients travelled a median of 124 (range 0.5-850) km and 2.3 (range 0.1-18.3) h each way, to reach the clinic. Only 2 children took insulin at school / college. Insulin adjustment for pre-meal blood glucose was practiced by 88%, but adjustment for meal intake by only 17% patients. Median HbA1c was lower in the participants with age > 18 y [7.7 (5.6-11.0) %] vs. < 10 y [8.3 (6.3-10.6) %, p < 0.02] or 10-18 y [(8.3 (5.9-12.6) %, p < 0.02)]. Overweight /obesity were seen in 35%. On multivariate regression, HbA1c was associated negatively with DKT score (DKTS) and age group, and DKTS was associated positively with urban residence and maternal education > class 12th. HbA1c and DKTS were not associated with income. CONCLUSIONS Low income may be successfully compensated by other factors to obtain good glycemic control. HbA1c did not deteriorate in adolescence in contrast to world experience. Overweight is a worrisome problem. Improved societal awareness about childhood diabetes is crucial.
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Affiliation(s)
- Pragya Mangla
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Suchit Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Aditi Chopra
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
| | - Ruchira Vishwakarma
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Pranjul Asthana
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
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Alassaf A, Odeh R, Gharaibeh L, Ibrahim S, Ajlouni K. Impact of Socioeconomic Characteristics on Metabolic Control in Children with Type 1 Diabetes in a Developing Country. J Clin Res Pediatr Endocrinol 2019; 11:358-365. [PMID: 30991788 PMCID: PMC6878341 DOI: 10.4274/jcrpe.galenos.2019.2019.0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Adequate glycemic control in children with type 1 diabetes reduces the risk of future complications. Identifying factors affecting haemoglobin A1c (HbA1c) is crucial to management of metabolic control. We aimed to identify possible socioeconomic predictors of poor metabolic control this patient group in Jordan, a developing country with limited resources. METHODS Medical charts of children with type 1 diabetes attending the pediatric endocrine clinics in two major diabetes centers were reviewed. HbA1c ≥7.5% (58 mmol/mol) was considered to reflect poor metabolic control. Logistic regression analysis was performed to identify predictors of poor glycemic control. The association between socioeconomic characteristics and metabolic control was evaluated using multiple correspondence analysis (MCA). RESULTS Two hundred and fifty-nine children were enrolled in the study. One fifth of the patients (20.5%) achieved HbA1c <7.5%. Patients with dietary non-compliance [odds ratio (OR): 3.533, confidence interval (CI): 1.803 - 6.926; p<0.001], and those who were overweight (OR: 3.869, CI: 1.218 - 12.294; p=0.022) were more likely to have poor metabolic control. Children whose mothers had a bachelor’s degree or higher were less likely to have poor metabolic control compared to children whose mothers had only elementary education (OR: 0.241, CI: 0.079 - 0.734; p=0.012). MCA revealed an association between low socioeconomic status and poor metabolic control. Children with deceased mothers had significantly higher HbA1c of 10.6±1.86% compared to an average of 8.7±1.45% for the rest of participants (p=0.005). CONCLUSION Low socioeconomic status, lower levels of maternal education and maternal death were associated with poor metabolic control. Identifying children with these risk factors might play an important role in optimizing metabolic control and provide better diabetes care.
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Affiliation(s)
- Abeer Alassaf
- University of Jordan Faculty of Medicine, Department of Pediatrics, Amman, Jordan,* Address for Correspondence: University of Jordan Faculty of Medicine, Department of Pediatrics, Amman, Jordan Phone: +96265353444 (2767) E-mail:
| | - Rasha Odeh
- University of Jordan Faculty of Medicine, Department of Pediatrics, Amman, Jordan
| | - Lubna Gharaibeh
- University of Jordan Faculty of Medicine, Department of Clinical Pharmacy, Amman, Jordan
| | - Sarah Ibrahim
- University of Jordan Faculty of Medicine, Department of Pediatrics, Amman, Jordan
| | - Kamel Ajlouni
- University of Jordan, The National Center (Institute) for Diabetes, Endocrinology and Genetics, Amman, Jordan
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Chopra A, Sudhanshu S, Chen Y, Mangla P, Dabadghao P, Bhatia E, Arora P, Bano S, Bhatia V. The impact of free medical supplies and regular telephonic contact on glycemic control in Indian children and adolescents with type 1 diabetes. Pediatr Diabetes 2019; 20:444-449. [PMID: 30861594 DOI: 10.1111/pedi.12844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/06/2019] [Accepted: 02/24/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE The effect of economic assistance to underprivileged families with type 1 diabetes has never been described. Such a study is relevant as logistic and cultural factors may preclude an anticipated good outcome. The objective of the study is to determine the impact of economic and educational intervention on hemoglobin A1c (HbA1c) and diabetes knowledge. METHODS Eighty-five consecutive participants were prospectively provided insulin and glucose strips for 1 year. From the 6th to 12th month, patients were randomized such that half of them (telephone group) received proactive telephonic advice by a diabetes educator, while the non-telephone group received usual care. HbA1c and diabetes knowledge were measured at baseline, 6 and 12 months. RESULTS Significant improvement was seen in HbA1c with provision of free diabetes supplies, when patients were compared with their own HbA1c values during the prior 36 months (baseline [8.38 ± 2.0%], at 3 months [8.0 ± 1.6%] and at 6 months [8.1 ± 1.5%, P = 0.0106]). Knowledge score increased from baseline (48 ± 15) to 6 months (58 ± 13, P < 0.001). No difference was seen between the telephone and non-telephone groups in HbA1c from the 6th to 9th and 12th month. The knowledge score showed significant improvement in the telephone group during the proactive telephonic advice study compared with the non-telephone group (P = 0.002). CONCLUSIONS The provision of free medical supplies improved HbA1c and diabetes knowledge. Intensive telephone contact improved knowledge, not HbA1c. These results provide important background for policy makers and diabetes management teams.
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Affiliation(s)
- Aditi Chopra
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pragya Mangla
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pratibha Arora
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sayda Bano
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Andrade CJDN, Alves CDAD. Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus. J Pediatr (Rio J) 2019; 95:48-53. [PMID: 29305827 DOI: 10.1016/j.jped.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. METHODS This was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. RESULTS A total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n=50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. CONCLUSIONS The socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.
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Affiliation(s)
| | - Crésio de Aragão Dantas Alves
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Hospital Universitário Prof. Edgard Santos, Departamento Pediátrico, Unidade de Endocrinologia Pediátrica, Salvador, BA, Brazil
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Alassaf A, Odeh R, Gharaibeh L, Ibrahim S, Ajlouni K. Personal and Clinical Predictors of Poor Metabolic Control in Children with Type 1 Diabetes in Jordan. J Diabetes Res 2019; 2019:4039792. [PMID: 31355293 PMCID: PMC6637667 DOI: 10.1155/2019/4039792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Achieving adequate metabolic control in children with type 1 diabetes is important in slowing the progression of future microvascular and macrovascular complications, but still it is a universal challenge. We aim to investigate possible factors associated with poor metabolic outcomes in Jordan as an example of a country with limited resources. METHODS This is a retrospective chart review study of children with type 1 diabetes. Several clinical and personal characteristics were tested for association with metabolic control reflected by HbA1c levels. Linear logistic regression analysis was used to evaluate possible predictors of metabolic control. One-way ANOVA analysis was used to detect significant differences in HbA1c between categories. RESULTS Significant predictors of metabolic control were found. A one-year increase in age led to an increase in HbA1c by 0.053% (P = 0.044). A decline in HbA1c levels was predicted in children who have precise amount of carbohydrates or who are receiving insulin at school (-0.46% (P = 0.014) and -0.82% (P = 0.004), respectively). When family members other than mothers decided the insulin dose, the HbA1c level increased by 0.74% (P = 0.005). CONCLUSION Poor metabolic control was associated with age, dietary noncompliance, not receiving insulin at school, and absence of direct mother care. Our study is one of the few studies from Middle East evaluating predictors of metabolic control. Global research studies help in giving universal insight towards developing more effective multidisciplinary team approach for diabetes care and education.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lubna Gharaibeh
- Department of Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
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Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Mendoza JA, Haaland W, D'Agostino RB, Martini L, Pihoker C, Frongillo EA, Mayer-Davis EJ, Liu LL, Dabelea D, Lawrence JM, Liese AD. Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes. Diabetes Res Clin Pract 2018; 138:128-137. [PMID: 29427695 PMCID: PMC5910177 DOI: 10.1016/j.diabres.2018.01.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/13/2018] [Accepted: 01/30/2018] [Indexed: 12/20/2022]
Abstract
AIMS Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI. METHODS Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants' HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey. RESULTS The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households. CONCLUSIONS FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.
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Affiliation(s)
- Jason A Mendoza
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Health Disparities Research Center, Fred Hutchinson Cancer Research Center/UW Cancer Consortium, Seattle, WA, USA.
| | - Wren Haaland
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lauren Martini
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Edward A Frongillo
- Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, USA
| | - Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lenna L Liu
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Center, Denver, CO, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA; Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Kandaswamy SK, Sharath A, Priya PG. Comparison of the Effectiveness of Probiotic, Chlorhexidine-based Mouthwashes, and Oil Pulling Therapy on Plaque Accumulation and Gingival Inflammation in 10- to 12-year-old Schoolchildren: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2018; 11:66-70. [PMID: 29991855 PMCID: PMC6034046 DOI: 10.5005/jp-journals-10005-1487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/18/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The use of a mouthwash augments mechanical removal of plaque by brushing and flossing and helps maintain oral health through its antiplaque and antibacterial chemical properties. Aim To evaluate the effectiveness of a probiotic mouthwash, sesame oil pulling therapy, and chlorhexidine-based mouth-wash on plaque accumulation and gingival inflammation in schoolchildren aged 10 to 12 years. Materials and methods The randomized controlled trial included 45 healthy schoolchildren aged 10 to 12 years and studying in Government High School, Tiruchengode, Tamil Nadu, India. The participants were randomly divided into three groups, I, II, and III, with 15 children in each group as follows: group I: probiotic mouthwash; group II: chlorhexidine mouthwash; and group III: sesame oil. Baseline scores of plaque index (PI) and modified gingival index (GI) were recorded followed by a full mouth oral prophylaxis. The designated mouth rinses were distributed to the respective groups and they were instructed to rinse once daily. Their parents supervised the children during the use of mouthwash. On the 15th and 30th day, the children were subjected to the same clinical measurements. Children’s acceptance of their plaque control method was assessed using a modified facial image scale. Results Intragroup comparisons for both the GI and PI scores were statistically significant (p ≤ 0.001) in all the three groups. Difference in the GI scores between the 15th and 30th day was statistically significant for chlorhexidine group alone (p = 0.024). Intergroup comparisons between the three groups were not statistically significant. Conclusion Probiotic mouthwash, chlorhexidine mouthwash, and sesame oil were equally effective in reducing plaque and in improving the gingival status of children. The difference between the gingival scores on the 15th and 30th day was statistically significant in the chlorhexidine group. How to cite this article: Kandaswamy SK, Sharath A, Priya PRG. Comparison of the Effectiveness of Probiotic, Chlorhexidine-based Mouthwashes, and Oil Pulling Therapy on Plaque Accumulation and Gingival Inflammation in 10- to 12-year-old Schoolchildren: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2018;11(2):66-70.
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Affiliation(s)
- Saravana K Kandaswamy
- Postgraduate Student, Department of Pedodontics and Preventive Dentistry, K.S.R. Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
| | - Asokan Sharath
- Professor and Head, Department of Pedodontics, K.S.R. Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
| | - Pr Geetha Priya
- Reader, Department of Pedodontics, K.S.R. Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
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Noueiri B, Nassif N. Impact of Diabetes Mellitus Type 1 on Lebanese Families' Quality of Life. Int J Clin Pediatr Dent 2018; 11:61-65. [PMID: 29991854 PMCID: PMC6034057 DOI: 10.5005/jp-journals-10005-1486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Diabetes mellitus type 1 (DM1) markedly alters the lives of individuals and their families. Family members can be affected by diabetes and its treatment, causing burden, distress, and reduced quality of life (QOL). Objective The aim of this research is to study the relationship between the diabetic child and the family members, to evaluate the stress and emotional issues between siblings, and to weigh in on the psychological, affective, and financial burden that parents have to deal with in their daily life. Materials and methods A total of 37 diabetic Lebanese families recruited from the Chronic Care Center (CCC) answered two questionnaires, one about general information and the other related to psychological and financial impact of DM1 and its oral complications on the families. Results About 56.8% have monthly income below $1,000; 16.2% of parents have an educational upper limit of college degree; 83.8% of the mothers are housewives; 75.7% of parents feel guilty about their child’s condition; 89.2% feel that their diabetic child is frustrated with their diet. For 78.4%, the siblings are jealous of the diabetic child; 13.5% of parents are well aware of the oral complications of diabetes and 86.5% think that treating the diabetic child’s teeth is more important than the siblings’ ones; 91.9% assist their diabetic child’s toothbrushing, but 81.1% of family members do not visit the dentist regularly. A total of 100% allocate special budget for the diabetic child’s diet and 59.4% have an additional budget dedicated to the diabetic child’s treatment; 81.1% declared that their career is affected by their child’s illness. Conclusion The diabetic child expressed frustration with their diet. The child’s siblings are jealous as they feel left behind. The parents experienced guilt feeling and psychological stress. They have social restriction and financial problems. The QOL of families living with a diabetic child is altered negatively. How to cite this article: Noueiri B, Nassif N. Impact of Diabetes Mellitus Type 1 on Lebanese Families’ Quality of Life. Int J Clin Pediatr Dent 2018;11(2):61-65.
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Affiliation(s)
- Balsam Noueiri
- Associate Professor, Department of Pediatric Dentistry, Lebanese University Beirut, Lebanon
| | - Nahla Nassif
- Associate Professor, Department of Pediatric Dentistry, Lebanese University Beirut, Lebanon
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Eray Ş, Uçar HN, Çetinkaya F, Eren E, Vural P. The Relationship Between Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus Adolescent Patients. J Clin Res Pediatr Endocrinol 2017; 9:253-259. [PMID: 28218068 PMCID: PMC5596807 DOI: 10.4274/jcrpe.3825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated. METHODS The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels. RESULTS The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%. CONCLUSION The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.
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Affiliation(s)
- Şafak Eray
- Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey
,* Address for Correspondence: Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey E-mail:
| | - Halit Necmi Uçar
- Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey
| | - Fatma Çetinkaya
- Taksim Training and Research Hospital, Clinic of Child Health and Diseases, İstanbul, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Pınar Vural
- Uludağ University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey
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Niba LL, Aulinger B, Mbacham WF, Parhofer KG. Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon. BMC Res Notes 2017; 10:207. [PMID: 28606170 PMCID: PMC5469010 DOI: 10.1186/s13104-017-2534-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those diagnosed have a dramatically reduced life expectancy (less than one year). The purpose of this study was to identify the predictors of glucose control in children and adolescents with type 1 diabetes. METHODS This hospital based cross-sectional study involved 76 children/adolescents (35 boys and 41 girls, mean age of 15.1 ± 3.1 years) with type 1 diabetes included in the "Changing Diabetes in Children" (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region of Cameroon. Data on glycosylated haemoglobin (HbA1c) was obtained from hospital records of participants. Information on socio-demographic characteristics and diabetes related practices were obtained from participants using a structured questionnaire. Odds ratios (OR) were calculated using logistic regression models to assess the association between determinants and good glyceamic control. RESULTS The study population had a mean HbA1c of 10.3 ± 2.9%. Bivariate analysis indicated that having a mother as the primary caregiver (OR 0.07, 95% CI 0.02-0.2), being on 2 daily insulin injections (OR 0.2, 95% CI 0.1-0.5) and good blood glucose monitoring (BGM) adherence (OR 0.1, 95% CI 0.04-0.3) were significantly (p < 0.001) associated with better HbA1c. Minimal/moderate caregiver involvement in BGM (OR 7.7, 95% CI 2.7-22.0) and insulin injection (OR 14.9, 95% CI 4.8-46.5) were significantly (p < 0.001) associated with poor outcome. Multivariate analysis showed that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002-0.189) was an independent predictor of good glucose control. CONCLUSIONS This study has shown that the mother's involvement in the diabetes management of their children and minimal/moderate caregiver involvement in the task of insulin injection are the most important determinants for good and poor glucose control respectively. It is currently unclear whether the direct involvement of the mother is causal or whether "mother as a primary caregiver" is just an indicator for a setting in which good diabetes treatment is possible.
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Affiliation(s)
- Loveline L. Niba
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Biochemistry, Catholic University of Cameroon (CATUC), P.O. Box 782, Bamenda, Cameroon
| | - Benedikt Aulinger
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
| | - Wilfred F. Mbacham
- Department of Physiology and Biochemistry, Faculty of Medicine, University of Yaoundé I, P.O. Box 8094, Yaoundé, Cameroon
| | - Klaus G. Parhofer
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
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Gesuita R, Skrami E, Bonfanti R, Cipriano P, Ferrito L, Frongia P, Iafusco D, Iannilli A, Lombardo F, Mozzillo E, Paleari R, Rabbone I, Sabbion A, Salvatoni A, Scaramuzza A, Schiaffini R, Sulli N, Toni S, Carle F, Cherubini V. The role of socio-economic and clinical factors on HbA1c in children and adolescents with type 1 diabetes: an Italian multicentre survey. Pediatr Diabetes 2017; 18:241-248. [PMID: 26990605 DOI: 10.1111/pedi.12378] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify the role of the family's socio-economic and clinical characteristics on metabolic control in children and adolescents with type 1 diabetes. METHODS In this cross-sectional, multicentre study, 768 subjects with type 1 diabetes under 18 years of age were consecutively recruited from January 2008 to February 2009. Target condition was considered for HbA1c values <7.5% (<58 mmol/mol). A multiple correspondence analysis (MCA) was performed to analyze the association between the socio-economic and clinical characteristics of the participants. A logistic regression analysis was performed to identify factors associated with the subjects metabolic control. In both analyses, the family's socio-economic status was represented, measured by the Hollingshead Four-Factor Index of Social Status (SES) or by parental years of education. RESULTS A total of 28.1% of subjects reached target HbA1c values. The MCA identified a strong association between at-target condition and several factors: high levels of SES or high levels of parental education, the use of the carbohydrate counting system, the use of insulin pumps, the use of the insulin delivery system over a short period of time, a normal body mass index. The logistic regression analysis showed that SES and the mother's years of education were significantly associated with the target condition [odds ratio (OR): 1.01, 95% confidence interval (CI): 1.01-1.03, p = 0.029; OR: 1.05, 95% CI: 1.01-1.10, p = 0.027, respectively). CONCLUSIONS Personal, clinical, and family characteristics were found to be associated with HbA1c target. Their identification can be crucial in addressing strategies to optimize metabolic control and improve diabetes management.
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Affiliation(s)
- Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Edlira Skrami
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Riccardo Bonfanti
- Centre of Paediatric Diabetology, San Raffaele Hospital, Milan, Italy
| | - Paola Cipriano
- Centre of Paediatric Diabetology, University of Chieti, Chieti, Italy
| | - Lucia Ferrito
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Paola Frongia
- Unit of Paediatric Diabetes, Brotzu Hospital, Cagliari, Italy
| | - Dario Iafusco
- Centre of Paediatric Diabetology, Second University of Naples, Naples, Italy
| | - Antonio Iannilli
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | | | - Enza Mozzillo
- Centre of Paediatric Diabetology, University Federico II, Naples, Italy
| | - Renata Paleari
- Department of Physiopathology and transplantation, University of Milan, Milan, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Alberto Sabbion
- Centre of Paediatric Diabetology, University of Verona, Verona, Italy
| | | | | | | | - Nicoletta Sulli
- Centre of Paediatric Diabetology, University La Sapienza, Rome, Italy
| | - Sonia Toni
- Pediatrics, AOU Meyer Children's Hospital, Florence, Italy
| | - Flavia Carle
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.,General Direction of Health Care Planning, Health Ministry, Rome, Italy
| | - Valentino Cherubini
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
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18
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Alonso Martín DE, Roldán Martín MB, Álvarez Gómez MÁ, Yelmo Valverde R, Martín-Frías M, Alonso Blanco M, Barrio Castellanos R. Impact of diabetes education on type 1 diabetes mellitus control in children. ACTA ACUST UNITED AC 2016; 63:536-542. [PMID: 27765490 DOI: 10.1016/j.endonu.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Diabetes education is an essential tool to achieve treatment objectives in type1 diabetes mellitus (T1DM). The aim of this study was to determine if understanding of diabetes by caregivers/patients or sociodemographic factors affect blood glucose control in children and adolescents with T1DM. PATIENTS AND METHODS The level of knowledge of 105 caregivers of children and adolescents with T1DM was assessed using a survey adapted to the type of treatment used (multiple dose insulin [MDI] or continuous subcutaneous insulin infusion [CSII]). Mean HbA1c levels in the previous year was considered as metabolic control marker. RESULTS Mean HbA1c levels were similar in both treatment groups, with slightly higher values in children over 12years of age. Patients on CSII had a longer time since disease onset and had poorer results, maybe because the items were more difficult due to the higher level of knowledge required for this treatment modality (P=.005). Caregivers with lower educational levels achieved poorer scores in the survey, but mean HbA1c levels of their children were lower, probably because of their greater involvement in disease care. CONCLUSIONS The level of knowledge of caregivers and/or patients with T1DM was high, and this was associated to good metabolic control. Studies to assess the impact of caregiver knowledge on metabolic control of children are needed.
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Affiliation(s)
- Daniel E Alonso Martín
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - M Belén Roldán Martín
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Ángeles Álvarez Gómez
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Rosa Yelmo Valverde
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Martín-Frías
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Milagros Alonso Blanco
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Raquel Barrio Castellanos
- Servicio de Pediatría, Unidad de Diabetes Pediátrica, Hospital Universitario Ramón y Cajal, Madrid, España
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Zakaria N, Mohd Yusof SA. Understanding Technology and People Issues in Hospital Information System (HIS) Adoption: Case study of a tertiary hospital in Malaysia. J Infect Public Health 2016; 9:774-780. [PMID: 27686258 DOI: 10.1016/j.jiph.2016.08.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/31/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hospital Information Systems (HIS) can improve healthcare outcome quality, increase efficiency, and reduce errors. The government of Malaysia implemented HIS across the country to maximize the use of technology to improve healthcare delivery, however, little is known about the benefits and challenges of HIS adoption in each institution. This paper looks at the technology and people issues in adopting such systems. METHODS The study used a case study approach, using an in-depth interview with multidisciplinary medical team members who were using the system on a daily basis. A thematic analysis using Atlas.ti was employed to understand the complex relations among themes and sub-themes to discover the patterns in the data. . RESULTS Users found the new system increased the efficiency of workflows and saved time. They reported less redundancy of work and improved communication among medical team members. Data retrieval and storage were also mentioned as positive results of the new HIS system. Healthcare workers showed positive attitudes during training and throughout the learning process. CONCLUSIONS From a technological perspective, it was found that medical workers using HIS has better access and data management compared to the previously used manual system. The human issues analysis reveals positive attitudes toward using HIS among the users especially from the physicians' side.
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Affiliation(s)
- Nasriah Zakaria
- The Research Chair of Health Informatics and Promotions, King Saud University, Riyadh, Kingdom Saudi Arabia.
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