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Schlarb P, Büttner JM, Tittel SR, Mönkemöller K, Müller-Godeffroy E, Boettcher C, Galler A, Berger G, Brosig B, Holl RW. Family structures and parents' occupational models: its impact on children's diabetes. Acta Diabetol 2024; 61:235-244. [PMID: 37847378 PMCID: PMC10866793 DOI: 10.1007/s00592-023-02187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
AIMS This study examines how family-related factors influence the management of children and adolescents with type 1 diabetes (T1DM). We investigate the relationship between family patterns, parental work schedules and metabolic control. MATERIALS AND METHODS We analysed data from a nationwide diabetes survey (DPV) focusing on HbA1c, severe hypoglycaemia, diabetic ketoacidosis, hospital admissions and inpatient treatment duration. We used linear regression and negative binomial regression models. Our study includes 15,340 children under the age of 18 with data on family structure and parental division of labour. RESULTS Children from two-parent households have better HbA1c outcomes than children from single-parent, blended or no-parent households (p < .0001). Higher HbA1C levels are associated with children living with an unemployed father, as opposed to those with full-time working parents or with a full-time working father and a part-time working mother (p < .001). CONCLUSIONS These findings emphasise the importance of carefully considering family structure and working time models in the management of paediatric T1DM. Our results highlight risk factors within the family environment and emphasise the need for family-focused counselling of high-risk patients or severe cases in clinical practice.
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Affiliation(s)
- Pauline Schlarb
- Centre of Child and Adolescent Medicine, Division of Family- and Child-Psychosomatics, Justus Liebig University, Klinikstrasse 36, 35392, Giessen, Germany
| | - Janina M Büttner
- Centre of Child and Adolescent Medicine, Division of Family- and Child-Psychosomatics, Justus Liebig University, Klinikstrasse 36, 35392, Giessen, Germany
| | - Sascha R Tittel
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Albert Einstein Alle 41, 89075, Ulm, Germany
- German Centre for Diabetes Research (DZD), Ingolstädter Landstrasse, 185764, Munich-Neuherberg, Germany
| | - Kirsten Mönkemöller
- Department of Pediatric and Adolescent Medicine, Kliniken Der Stadt Köln gGmbH, Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Esther Müller-Godeffroy
- Department of Pediatric and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Claudia Boettcher
- Pediatric Endocrinology and Diabetology, University of Berne, University Children's Hospital, Freiburgstrasse 15, 3010, Berne, Switzerland
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Sozialpädiatrisches Zentrum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gabriele Berger
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf, Karl-Aschenbrenner-Gasse 3, 1210, Vienna, Austria
| | - Burkhard Brosig
- Centre of Child and Adolescent Medicine, Division of Family- and Child-Psychosomatics, Justus Liebig University, Klinikstrasse 36, 35392, Giessen, Germany.
| | - Reinhard W Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Albert Einstein Alle 41, 89075, Ulm, Germany
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Turin A, Drobnič Radobuljac M. Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review. World J Diabetes 2021; 12:1518-1529. [PMID: 34630904 PMCID: PMC8472498 DOI: 10.4239/wjd.v12.i9.1518] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one's life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.
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Affiliation(s)
- Anja Turin
- Department for Child Psychiatry, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Maja Drobnič Radobuljac
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
- Unit for Intensive Child and Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana 1000, Slovenia
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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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Yayan EH, Zengin M, Erden Karabulut Y, Akıncı A. The relationship between the quality of life and depression levels of young people with type I diabetes. Perspect Psychiatr Care 2019; 55:291-299. [PMID: 30614548 DOI: 10.1111/ppc.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/11/2018] [Accepted: 12/09/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study is to examine the relationship between the quality of life and depression levels of the youth with type I diabetes. DESIGN AND METHODS: The study was a cross-sectional descriptive study. FINDINGS It was found that there is a negative correlation between participants' HbA1c levels and quality of life, and a positive correlation between HbA1c levels and depression. It was determined that quality of life and depression are significant predictors of HbA1c (R 2 = 0.72, P < 0.01). PRACTICE IMPLICATIONS The depression levels of the young people with increased and their metabolic control was affected negatively as the quality of life levels decreased. Depression measurements should be made during the routine control of youth with diabetes who have difficulty in maintaining metabolic control.
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Affiliation(s)
- Emriye Hilal Yayan
- Department of Child Health and Disease Nursing, Health Sciences of Faculty, İnönü University, Malatya, Turkey
| | - Mürşide Zengin
- Department of Nursing, School of Health, Adıyaman University, Adıyaman, Turkey
| | | | - Ayşehan Akıncı
- Department of Pediatric Endocrinology, İnönü University, Turgut Özal Medical Center, Malatya, Turkey
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Gloaguen E, Bendelac N, Nicolino M, Julier C, Mathieu F. A systematic review of non-genetic predictors and genetic factors of glycated haemoglobin in type 1 diabetes one year after diagnosis. Diabetes Metab Res Rev 2018; 34:e3051. [PMID: 30063815 DOI: 10.1002/dmrr.3051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/13/2022]
Abstract
Type 1 diabetes (T1D) results from autoimmune destruction of the pancreatic βcells. Although all T1D patients require daily administration of exogenous insulin, their insulin requirement to achieve good glycaemic control may vary significantly. Glycated haemoglobin (HbA1c) level represents a stable indicator of glycaemic control and is a reliable predictor of long-term complications of T1D. The purpose of this article is to systematically review the role of non-genetic predictors and genetic factors of HbA1c level in T1D patients after the first year of T1D, to exclude the honeymoon period. A total of 1974 articles published since January 2011 were identified and 78 were finally included in the analysis of non-genetic predictors. For genetic factors, a total of 277 articles were identified and 14 were included. The most significantly associated factors with HbA1c level are demographic (age, ethnicity, and socioeconomic status), personal (family characteristics, parental care, psychological traits...) and features related to T1D (duration of T1D, adherence to treatment …). Only a few studies have searched for genetic factors influencing HbA1c level, most of which focused on candidate genes using classical genetic statistical methods, with generally limited power and incomplete adjustment for confounding factors and multiple testing. Our review shows the complexity of explaining HbA1c level variations, which involves numerous correlated predictors. Overall, our review underlines the lack of studies investigating jointly genetic and non-genetic factors and their interactions to better understand factors influencing glycaemic control for T1D patients.
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Affiliation(s)
- Emilie Gloaguen
- Inserm UMRS-958, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Marc Nicolino
- Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Cécile Julier
- Inserm UMRS-958, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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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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Litmanovitch E, Geva R, Rachmiel M. Short and long term neuro-behavioral alterations in type 1 diabetes mellitus pediatric population. World J Diabetes 2015; 6:259-270. [PMID: 25789107 PMCID: PMC4360419 DOI: 10.4239/wjd.v6.i2.259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) is one of the most prevalent chronic conditions affecting individuals under the age of 18 years, with increasing incidence worldwide, especially among very young age groups, younger than 5. There is still no cure for the disease, and therapeutic goals and guidelines are a challenge. Currently, despite T1DM intensive management and technological interventions in therapy, the majority of pediatric patients do not achieve glycemic control goals. This leads to a potential prognosis of long term diabetic complications, nephrological, cardiac, ophthalmological and neurological. Unfortunately, the neurological manifestations, including neurocognitive and behavioral complications, may present soon after disease onset, during childhood and adolescence. These manifestations may be prominent, but at times subtle, thus they are often not reported by patients or physicians as related to the diabetes. Furthermore, the metabolic mechanism for such manifestations has been inconsistent and difficult to interpret in practical clinical care, as reported in several reviews on the topic of brain and T1DM. However, new technological methods for brain assessment, as well as the introduction of continuous glucose monitoring, provide new insights and information regarding brain related manifestations and glycemic variability and control parameters, which may impact the clinical care of children and youth with T1DM. This paper provides a comprehensive review of the most recently reported behavioral, cognitive domains, sleep related, electrophysiological, and structural alterations in children and adolescences from a novel point of view. The review focuses on reported impairments based on duration of T1DM, its timeline, and modifiable disease related risk parameters. These findings are not without controversy, and limitations of data are presented in addition to recommendations for future research direction.
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