Financial burden for families of children with type 1 diabetes: a cross-sectional survey from North India

Financial Toxicity in Diabetes: The State of What We Know

PURPOSE OF REVIEW

This systematic examination quantifies financial toxicity- the economic burden and related financial distress experienced by patients due to medical costs- in diabetes management globally, analyzing prevalence, mechanisms, and interventions across diverse healthcare systems and geographic contexts.

RECENT FINDINGS

Data indicates 30-60% of diabetes patients experience financial toxicity, with household expenditures ranging from 5 to 40% of income on disease management, and demographic disparities evident. Current intervention strategies demonstrate limited efficacy, particularly in resource-constrained settings, while policy approaches show mixed results across economic contexts. Financial toxicity operates through four identified pathways: direct expenses, indirect costs (productivity/caregiver burden), insurance coverage limitations, and structural access barriers. Research priorities include developing validated measurement instruments for diabetes financial toxicity, implementing contextually appropriate interventions, and establishing causative relationships between financial burden and clinical outcomes through longitudinal studies.

Assessment of Quality of Life of Children and Adolescents with Type 1 Diabetes in Bahrain Using PedsQL 3.2 Diabetes Module

Background/Objectives: Living with type 1 diabetes (T1D) significantly impacts children and adolescents, affecting their physical, emotional, and social well-being. Poor glycemic control (HbA1c > 7.5%) is linked to lower health-related quality of life (HRQoL), highlighting the need for effective management. This study aimed to assess the HRQoL and evaluate the associations between various factors and domains of HRQoL among children and adolescents with T1D in Bahrain. Methods: This cross-sectional study enrolled 182 children and adolescents from 5 to 16 years with T1D from a tertiary care hospital. Participants had T1D for at least six months and were interviewed during regular follow-ups. Participants Outside the target age group and those with any comorbidity were excluded. Data collection involved demographic and diabetes-related information. The PedsQL 3.2 Diabetes Module was used to assess HRQoL. Results: The mean age at diagnosis was 6.83 ± 3.11 years, with 57.7% diagnosed between 6 and 11 years. The sample was gender-balanced (52.2% male, 47.8% female). Treatment adherence had the highest median score (80.0), while worry was the lowest (58.33). Diabetes symptoms were associated with family income, school performance, HbA1c, and emergencies. Treatment barriers were linked to age, education, insulin regimen, and glucometer type. Adherence correlated with age, age at diagnosis, sex, BMI, education, and comorbidities, with family income (β = 4.69, p = 0.032) and school performance (β = -22.986, p < 0.001) being significant predictors. Treatment adherence was negatively impacted by younger age (β = -20.651 for 6-8 years, β = -12.002 for 9-12 years, both p < 0.01) and comorbidities (β = -12.286, p = 0.021). Conclusions: This study highlights the significant impact of various factors on the HRQoL of children and adolescents with T1D in Bahrain, emphasizing the need for targeted interventions to improve their overall well-being.

Transitioning to Insulin Analogs in Tunisian Children with Type 1 Diabetes: Efficacy and Safety

INTRODUCTION

there is a lack of research evaluating the impact of therapeutic switching from human insulin to analogues, particularly in paediatric populations from low- and middle-income countries.

AIM

The study aimed to retrospectively assess the effectiveness and safety of transitioning from human insulin to insulin analogs in Tunisian children with diabetes.

METHODS

This retrospective descriptive study included children with type 1 diabetes who changed their insulin therapy protocol after at least one year of treatment with human insulin. Clinical, therapeutic, and glycaemic homeostasis parameters were assessed following the transition from human insulin (NPH + rapid-acting insulin) to the Basal-Bolus insulin analog- protocol.

RESULTS

The study included 60 patients. Following the switch, all patients showed a significant reduction in mean fasting blood glucose levels (11.11 mmol/l vs. 8.62 mmol/l; p=0.024). Glycated haemoglobin A1C levels decreased notably in children who adhered to their diet (from 9.93% to 8.38%; p=0.06) and/or engaged in regular physical activity (from 10.40% to 8.61%; p=0.043). The average number of hypoglycemic events per year decreased from 4.03 events/year to 2.36 events/year (p=0.006), along with a decrease in the rate of patients hospitalized for acid-ketotic decompensation (from 27% to 10%; p=0.001). Financial constraints led to 82% of patients reusing microfine needles ≥2 times per day, and 12% were compelled to revert to the initial insulin therapy protocol due to a lack of access to self-financed microfine needles or discontinued social coverage.

CONCLUSIONS

Although insulin analogues offer clear benefits, their use poses challenges as a therapeutic choice for children with diabetes in low- to middle-income countries. These challenges hinder the achievement of optimal glycemic control goals.

The Social and Financial Burden on Families of Type 1 Diabetic Pediatric Patients in Madinah Region, Saudi Arabia

INTRODUCTION

Caregivers and families play an essential role in managing and caring for type 1 diabetes mellitus (T1DM) pediatric patients. However, caregiving is usually associated with social and financial burdens. This study assesses the burden and underlying social and financial factors among Saudi caregivers of pediatric patients with T1DM.

METHODS

A cross-sectional study was conducted among caregivers and families of T1DM pediatric patients attending the Diabetic Center at King Fahad Hospital (KFH) and the Diabetic Center at King Salman Bin Abdulaziz Medical City (KSAMC) in Al-Madinah City, Kingdom of Saudi Arabia (KSA) from January 2024 to June 2024. The data collection was done using the Zarit Burden Questionnaire and the Caregiver Care Cost Assessment Questionnaire.

RESULTS

The study surveyed 376 participants, primarily females (N = 285, 75.8%) and married (N = 317, 84.3%), with a majority aged between 18 and 47 years (N = 322, 85.6%). The burden experienced by families with T1DM pediatric patients was moderate, with a mean total burden level score of 27.8 ± 16.3. For those employed, most reported working as usual (N = 107, 81.1%), with most spending less than two hours on care weekly (N = 76, 57.6%). A significant association was found between the financial impact of caregiving on saving, spending, and general financial stress and social burden (p < 0.01).

CONCLUSION

The findings show a moderate burden faced by caretakers of T1DM pediatric patients, with a strong correlation between the financial impact of caregiving on saving, spending, and general financial stress and burden level. The findings also highlight the significant impact of caregiving on the financial stress and lifestyle changes that caregivers endure.

Practice of complementary and alternative medicine use in North Indian children with type 1 diabetes: an exploratory study

Purpose

Intermittent or concurrent use of Complementary and Alternative medicines (CAM) with insulin may have adverse effects in children with Type 1 Diabetes (T1DM). This study explores the practices of CAM use in children with T1DM.

Methods

An exploratory study was conducted among parents of children with T1DM attending a tertiary-level diabetes clinic. Data were collected using a structured pre-tested questionnaire.

Results

Two-hundred parents were invited; 183 (91.5%) completed the study. The mean age of the children was lower among CAM users than others (7.9 ± 4.3 vs 9.3 ± 4.3 years, p 0.032). The two groups were similar in gender, family income, parental education, and age at diagnosis. Sixty-seven (36.6%) had used CAM. The parents' reasoning for CAM use was to cure diabetes (62.7%), to improve glycemic control (28.3%), or considering it harmless (17.9%). The most commonly used CAMs were Ayurveda (32.8%) and homeopathic preparations (31.3%). The time interval between diagnosis and CAM use ranged from 1 day to 4 years. The duration of CAM use varied widely; 50.7% used CAM for < 1 month. Only 10 CAM users had HbA1C estimated during CAM use; their mean HbA1C was 12.4 ± 3.6%. Twenty-seven CAM users (40.2%) reported poorer glycemic control; 26.8% had no effect, and the rest had undefined effects due to too short duration of use.

Conclusion

CAM, mostly herbal, is frequently used among children with T1DM in North India and has detrimental effects on glycemic control. This information should be used during diabetes education to avoid medical emergencies related to sub-optimal insulin dosing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-023-00663-9.

Caregivers' knowledge and medication adherence in children with thyroid disorders: an exploratory study

OBJECTIVES

Many thyroid disorders in children demand long-term therapy. The parent's understanding of the child's condition is of utmost importance for adherence to treatment. The study objective was to assess the knowledge, medication adherence, reasons for non-adherence, and their relationship with various clinical parameters.

METHODS

An exploratory, cross-sectional study with a total enumeration sampling technique was conducted between July 2022 and September 2022. Children and young adults aged ≤18 years who were diagnosed with a thyroid disorder and taking medications for at least 3 months were included. Data were collected by interviewing parents using the Adherence to Refills and Medications Scale (ARMS) and structured knowledge questionnaire.

RESULTS

Parents of 102 children were interviewed. The mean age of the children was 9.2 ± 0.4 years; 58 (57 %) were girls. The mean duration of treatment was 5.5 ± 0.3 years. Many (66 %) informants were mothers. Three-fourths (75.5 %) of parents were educated up to senior secondary and above. Most (91.2 %) of parents had poor knowledge about the disease and its management. Poor disease knowledge was significantly linked to lower education (p<0.001). Nonetheless, strong adherence (>80 %) was noted on the ARMS scale. No significant correlation was found between physical growth, thyroid function, and adherence/knowledge (p-values 0.20-0.71).

CONCLUSIONS

The caregivers' knowledge of thyroid disorders was poor and related to their educational level. There is a need to use clear language and ensure that parents have an adequate understanding of their child's condition. Healthcare professionals should assess and address gaps in parental knowledge and adherence.

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

Background

Diabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out-of-pocket health expenditure (OOPE) and financial burden associated with DM care in India.

Methods

The study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.

Results

In India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM-affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5-fold and 2.5-fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities.

Conclusion

The burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.