Gordon Erin N, Dykeman Blair, Greco Kimberly F, Liu Enju, Rhodes Erinn T, Garvey Katharine C
Clinical Nutrition, Boston Children's Hospital, Boston, MA.
Clinical Research Center, Boston Children's Hospital, Boston, MA.
Diabetes Spectr. 2024 Mar 7;37(3):254-263. doi: 10.2337/ds23-0051. eCollection 2024 Summer.
Many children with type 1 diabetes do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of registered dietitian (RD) visits or how satisfied they are with nutrition care. This study aimed to evaluate nutrition experiences and perceptions of care among caregivers of children with type 1 diabetes at an academic medical center. We analyzed 159 survey responses. Using multivariable logistic regression, we assessed factors associated with the perception of need for annual nutrition visits, satisfaction with RD care, and encouragement from a nurse or doctor to meet with an RD. Covariates included age (<13 vs. ≥13 years), type 1 diabetes duration (≤3 vs. >3 years), sex, race/ethnicity, and insulin pump and continuous glucose monitoring use. More than half of caregivers (56%) considered annual visits necessary. Shorter type 1 diabetes duration (odds ratio [OR] 1.92, 95% CI 1.02-3.63) was associated with this finding. Less than half (46.5%) reported satisfaction with nutrition care; higher satisfaction was also correlated with shorter type 1 diabetes duration (OR 2.20, 95% CI 1.17-4.15). Although 42% reported meeting with an RD in the past year, less than two-thirds (62%) reported receiving a medical provider recommendation for nutrition care. Leading reasons for not meeting with an RD were "I am knowledgeable in nutrition and do not need to see an [RD]" (41%) and "I had a past visit with an [RD] that was not helpful" (40%). Our findings suggest that satisfaction with and perceived need for nutrition care may wane with longer type 1 diabetes duration. Improved strategies for therapeutic alliance between caregivers and RDs and engagement of families at later stages of type 1 diabetes are needed.
许多1型糖尿病患儿未达到营养指南的要求。对于照护者如何看待注册营养师（RD）问诊的必要性以及他们对营养护理的满意度知之甚少。本研究旨在评估一所学术医疗中心中1型糖尿病患儿照护者的营养体验和护理认知。我们分析了159份调查问卷的回复。使用多变量逻辑回归，我们评估了与年度营养问诊需求认知、对RD护理的满意度以及护士或医生鼓励与RD会面相关的因素。协变量包括年龄（<13岁与≥13岁）、1型糖尿病病程（≤3年与>3年）、性别、种族/族裔以及胰岛素泵和持续葡萄糖监测的使用情况。超过一半（56%）的照护者认为年度问诊是必要的。这一结果与较短的1型糖尿病病程相关（比值比[OR]为1.92，95%置信区间为1.02 - 3.63）。不到一半（46.5%）的照护者报告对营养护理感到满意；更高的满意度也与较短的1型糖尿病病程相关（OR为2.20，95%置信区间为1.17 - 4.15）。尽管42%的照护者报告在过去一年中与RD见过面，但不到三分之二（62%）的照护者报告收到过医疗服务提供者关于营养护理的推荐。未与RD见面的主要原因是“我对营养知识了解很多，不需要看[RD]”（41%）和“我过去与[RD]见过面，但没什么帮助”（40%）。我们的研究结果表明，随着1型糖尿病病程延长，对营养护理的满意度和需求认知可能会降低。需要改进照护者与RD之间治疗联盟的策略以及在1型糖尿病后期让家庭参与进来。
