Hubert H. Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota.
School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota.
Pediatr Diabetes. 2018 May;19(3):527-533. doi: 10.1111/pedi.12567. Epub 2017 Aug 15.
Parental care influences outcomes for children's type 1 diabetes (T1D). There is little evidence about the impact of parental caregiving in developing countries, where fixed dose human insulin (conventional) therapy and limited self-monitoring of blood glucose are common. This article investigates whether performance of key T1D management tasks by children or their caregivers impacts hemoglobin A1c (HbA1c).
We surveyed the caregivers of 179 children with T1D routinely treated in a specialized diabetes clinic in Maharashtra, India to determine who performs key diabetes care tasks: child or parent. We used linear regression to estimate the relationship between parental caregiving and HbA1c, and how this association varies by child age and time since diagnosis.
Caregivers of older children were less involved in care tasks, though caregivers of 11- to 18-year olds performed more care for children diagnosed for a longer duration. Parental involvement in key insulin delivery tasks was associated with lower HbA1c levels for all children. These reductions were greatest among children 11 to 14 years old and diagnosed for less than 2 years: mean HbA1c levels were 8.5% (69 mmol/mol) if the caregiver, and 14.4% (134 mmol/mol) if the child, performed the tasks (P < .05).
Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.
父母的照顾对儿童 1 型糖尿病（T1D）的结局有影响。在发展中国家，有关父母照顾的影响的证据很少，这些国家通常采用固定剂量的人胰岛素（常规）治疗和有限的血糖自我监测。本文研究了儿童或其照顾者执行 T1D 管理关键任务的情况是否会影响血红蛋白 A1c（HbA1c）。
我们调查了在印度马哈拉施特拉邦一家专门的糖尿病诊所接受常规治疗的 179 名 T1D 患儿的照顾者，以确定谁执行关键的糖尿病护理任务：儿童或家长。我们使用线性回归来估计父母照顾与 HbA1c 之间的关系，以及这种关联如何随儿童年龄和诊断后时间的变化而变化。
年龄较大的儿童的照顾者较少参与护理任务，但 11 至 18 岁儿童的照顾者对诊断时间较长的儿童进行更多的护理。父母参与关键的胰岛素输送任务与所有儿童的 HbA1c 水平降低有关。在 11 至 14 岁且诊断时间不到 2 年的儿童中，这些降低最为显著：如果照顾者执行任务，则平均 HbA1c 水平为 8.5%（69mmol/mol）；如果是儿童执行任务，则平均 HbA1c 水平为 14.4%（134mmol/mol）（P<0.05）。
儿童在生命早期被诊断出 T1D 后，其父母会一直参与到孩子的青春期。在儿童被诊断为晚期儿童和青春期早期的儿童中，父母的参与程度明显较低，这与血糖控制较差有关。诊所必须了解谁执行护理任务，并适当调整糖尿病教育。
