Children's Diabetes Research Articles

"When I gave him the insulin injection, I felt the pain in my heart": Experiences of parents of young children with type 1 diabetes in an Arab country.

Type 1 diabetes mellitus in children is one of the most common chronic health conditions, requiring constant monitoring and care. Living with children who are diagnosed with chronic illness affects multiple aspects of parents' daily lives, including the physical, mental, and social aspects. Due to their child's diabetes, parents may experience many special difficulties with their daily responsibilities. This study describes parental experiences caring for a child with type 1 diabetes. The study was based on semi-structured interviews with 10 parents caring for a child with type 1 diabetes. We analyzed the interviews using Colaizzi's strategy of descriptive phenomenological data analysis in nursing research. Participants were described a profoundly challenging situation, and they were in need of support to help them handle a challenging life situation, especially during the first years of a child's diagnosis. The following themes emerged from the data: adapting to the new reality after diagnosis, keeping up with the child's treatment regimen, psychological, social, and financial burdens, and staying tuned for complications.

GABA-mediated inhibition of human CD4+ T cell functions is enhanced by insulin but impaired by high glucose levels

γ-aminobutyric acid (GABA), known as the main inhibitory neurotransmitter in the brain, exerts immunomodulatory functions by interaction with immune cells, including T cells. Metabolic programs of T cells are closely linked to their effector functions including proliferation, differentiation, and cytokine production. The physiological molecules glucose and insulin may provide environmental cues and guidance, but whether they coordinateto regulate GABA-mediated T cell immunomodulation is still being examined. CD4+ T cells that were isolated from blood samples from healthy individuals and from patients with type 1 diabetes (T1D) were activated invitro. We carried out metabolic assays, multiple proximity extension assay (PEA), ELISA, qPCR, immunoblotting, immunofluorescence staining, flow cytometry analysis, MS-based proteomics, as well as electrophysiology and live-cell Ca2+ imaging. We demonstrate that GABA-mediated reduction of metabolic activity and the release of inflammatory proteins, including IFNγ and IL-10, were abolished in human CD4+ T cells from healthy individuals and patients with T1D when the glucose concentration was elevated above levels typically observed in healthy people. Insulin increased GABAA receptor-subunit ρ2 expression, enhanced the GABAA receptors-mediated currents and Ca2+ influx. GABA decreased, whereas insulin sustained, hexokinase activity and glycolysis in a glucose concentration-dependent manner. These findings support that metabolic factors, such as glucose and insulin, influence the GABA-mediated immunomodulation of human primary T cells effector functions. The Swedish Children's Diabetes Foundation, The Swedish Diabetes Foundation, The Swedish Research Council 2018-02952, EXODIAB, The Ernfors Foundation, The Thurings Foundation and the Science for Life Laboratory.

Development and psychometric evaluation of the type 1 diabetes mellitus self-management scale for parents

Background/aimDiabetes has become a global epidemic, necessitating effective self-management strategies. This is particularly crucial for parents of children with type 1 diabetes mellitus, as they must make numerous daily decisions and perform complex care activities. Therefore, the aim of this study was to develop a comprehensive diabetes self-management scale specifically for parents of children with type 1 diabetes. This scale aims to holistically address behaviors impacting diabetes self-management and to evaluate its psychometric properties.Materials and methodsA methodological, correlational, and cross-sectional study was conducted with a sample of 190 parents of children with type 1 diabetes mellitus. The scale items were reviewed by five experts to ensure they adequately covered the parents' evaluation of their children's diabetes self-management. Following this, a Turkish language expert assessed the draft scale for language accuracy, comprehensibility, and grammar. The data were analyzed using descriptive statistics (numbers and percentages), Cronbach's α reliability coefficient, factor analysis, and correlation analysis.ResultsThe Cronbach's alpha for the overall scale was 0.893, and the Cronbach's alpha for the subscales was between 0.757 and 0.845. The item-total score correlations ranged between 0.408 and 0.660 (p < .05). The exploratory factor analysis showed that the scale explained 61.427% of the total variance, and the factor loadings of items ranged from 0.574 to 0.859. The confirmatory factor analysis also showed that the factor loadings of the scale items ranged from 0.574 to 0.859.Conclusion: The validity and reliability analyses revealed that the scale is a valid and reliable measurement tool for the Turkish culture.

Insomnia severity among caregivers of children with type 1 diabetes: A mixed method study

AimThis research was conducted to assess the severity of insomnia experienced by caregivers of children with type 1 diabetes. MethodIn this study, a mixed-method descriptive sequential pattern design was employed, incorporating both qualitative and quantitative research methods. In the study, 152 caregivers were surveyed for quantitative data on survey form and insomnia severity. Additionally, 9 mothers underwent semi-structured interviews for qualitative insights. ResultsOf caregivers, 13.8% were identified to experience clinical insomnia. There were statistically significant differences in insomnia severity index scores in terms of experiencing sleep problems after the child's type 1 diabetes diagnosis, caregivers having adequate sleep duration at night, how they felt on waking in the morning, difficulty managing their child's diabetes the next day due to lack of sleep, difficulty getting to sleep at night, sleeping more than one hour during the day, lack of sleep due to caring and treatment, lack of sleep due to not meeting the desired targets for blood glucose values and receiving support for type 1 diabetes management due to lack of sleep (p < 0.05). Three themes were identified as a result of qualitative analysis: Sleep status of caregivers, effect of sleep problems on daily life and solving sleep problems. ConclusionsCaregivers experience insomnia during the process of type 1 diabetes management and this situation affects their daytime care duties. Practical implicationsResearch shows caregivers of children with type 1 diabetes often face insomnia, highlighting the need for solutions.

Family structures and parents’ occupational models: its impact on children’s diabetes

AimsThis 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 methodsWe 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.ResultsChildren 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).ConclusionsThese 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.

Psychological experiences and perceived social support

Introduction: Mothers are often the primary caregivers of children in Indian homes. Mothers of children with Type 1 diabetes experience an emotional toll of this challenging responsibility that the lack of social support can exacerbate. Health care for children with Type 1 diabetes in India commonly addresses the medical condition and its associated symptoms, whereas mothers, who bear the primary responsibility of the children's care, are most often neglected. This study aimed to understand the psychological experiences and perceived social support of Indian mothers whose children are diagnosed with Type 1 diabetes. Methods: This phenomenological research was conducted using semi-structured interviews with mothers using purposive sampling between the ages of 24 and 45 years (n = 13) and analyzed using thematic analysis. The data analysis and collection were done between January 2022 and December 2022. Results: Thematic analysis revealed six main themes of psychological distress, multifold strain, poor Type 1 diabetes mellitus education and stigma, need for social and familial support, caregiver burden, and coping. The findings from this research suggest that such experiences can make it difficult for them to cope with their child's diabetes and have a negative impact on their mental health. Conclusion: This study highlights the need for culture-appropriate interventions to address the social and emotional needs of such mothers. It is essential to educate families and the community as a whole about the needs of both mothers and children with Type 1 diabetes.

722-P: The Value of Collaborative Parental Involvement in Diabetes Management for Youth with Type 1 Diabetes

Type 1 diabetes (T1D) is typically diagnosed during late childhood or early adolescence. Parents are often initially responsible for their child's diabetes management, which transfers to the child over time. The Collaborative Parent Involvement (CPI) Scale measures the child's perceived quality of parental involvement in their diabetes care. We examined the relationship between CPI and other key factors of child and adolescent T1D management: self-care, Diabetes Family Conflict (DFC), and Pediatric Quality of Life (PedsQL). Data were collected from participants in a randomized controlled trial which included adolescents with T1D (age 11-17) and their female caregivers. Participants completed baseline surveys, including the CPI, DFC, and PedsQL, as well as a parent- and self-report measure of how well the child manages their diabetes. HbA1c was extracted from adolescents’ medical charts. Bivariate correlations were used to assess relationships between CPI and other diabetes outcomes. Higher levels of collaborative parenting were associated with greater self- and parent-reports of perceived self-care (r= .23, .22, both p&amp;lt;.01). In contrast, greater collaboration was associated with lower levels of child- and parent-reported diabetes-specific conflict (r= -.23, -.20, p&amp;lt;.01, p&amp;lt;.05). Higher levels of collaboration were also associated with higher quality of life (r= .45, p&amp;lt;.01) and lower HbA1c (r= -.28, p&amp;lt;.01). No significant differences in CPI scores were found related to child gender, race/ethnicity, diabetes device use, or between different income groups. Findings indicate that adolescents’ perceived quality of parental involvement is associated with several key factors of T1D management. While the quantity of parental involvement is often a targeted area in pediatric T1D care, clinicians and parents should also focus on the quality of involvement. Enhanced parent-child collaboration may help families handle the many stressors associated with T1D management. Disclosure K.I.Anifowoshe: None. S.S.Jaser: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK11545)

Diabetes in School Health (DiSH): Telementoring Collaboration Between Pediatric Diabetes Specialists and School Nurses to Improve Care of Children With Diabetes.

Rates of diabetes in youth are rising and more than 1 million children have diabetes. School nurses are central to a school-aged child's diabetes care and they must make important moment-to-moment decisions requiring understanding of and comfort with diabetes care and technology. The rapid changes in diabetes care and technology make ongoing education essential, yet access to up-to-date and practical education is limited for many school nurses. Integrating needs data and stakeholders' input, this group developed Diabetes in School Health (DiSH) to address this gap. We adapted a well-established, innovative, and easily-accessible telementoring educational model, Project ECHO, to create a collaborative learning community. In the first year, 9 diabetes experts and >150 school nurses joined live DiSH sessions. DiSH has been well-received by the school community and next steps include expansion of DiSH to other states and study of impact of DiSH on health disparities.

Childhood onset type 1 diabetes in Western Australia: an update on incidence and temporal trends from 2001 to 2022.

To determine the incidence and incidence trends over 2001-2022 of childhood onset type 1 diabetes (T1D) in Western Australia and assess the impact of the COVID-19 pandemic. Children newly diagnosed with T1D aged 0-14 years in Western Australia from 1 January 2001 to 31 December 2022 were identified from the population-based Western Australian Children's Diabetes Database. Annual age- and sex- specific incidence was calculated, and Poisson regression used to analyse trends by calendar year, month, sex and age group at diagnosis. Pandemic era impacts were also examined using the regression model adjusted for sex and age group. Between 2001 and 2022, 2311 children (1214 boys, 1097 girls) were newly diagnosed with T1D aged 0-14 years, giving an overall mean annual incidence of 22.9 per 100,000 person-years (95% CI: 22.0, 23.9), with no significant difference observed between boys and girls. A significant linear increasing trend was only observed in 10-14 year olds with boys and girls combined (1.2% per year (IRR 1.012 (95% CI: 1.002, 1.022))). No significant difference in the incidence was observed between the pre- and post-pandemic period. The incidence of type 1 diabetes in 0-14 year old Western Australian children continues to increase in the oldest age group. Longer term monitoring of the incidence during the COVID-19 pandemic is needed to determine its impact in this globally unique population which experienced a delayed start to the pandemic with severe containment measures remaining in place until January 2022.

Retraction Note: Fresh hetero-metallic Compound as Luminescent Sensor for Detection of CS2 and Inhibitory Activity on Children Diabetes.

Retraction Note: Fresh hetero-metallic Compound as Luminescent Sensor for Detection of CS2 and Inhibitory Activity on Children Diabetes.

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

Are fathers involved in diabetes management? A rapid review

This rapid review aimed to synthesise the evidence on father involvement in managing their child's type 1 diabetes. We identified eight articles from EBSCO, Science Direct, Academic Search Premier, Psyclnfo, PsycArticles, and Google Scholar. Studies were included if they provided information on fathers' involvement in diabetes management, were published between 2010 to 2020 in English as full-text peer reviewed articles, and employed qualitative, quantitative, or mixed-methods. Following thematic synthesis, findings indicated that fathers were directly involved in blood glucose checking and planning of diabetes management tasks, and indirectly in terms of finances, general care of the child, and advocating in schools for children living with diabetes. These findings suggest fathers involved in the management of their child's diabetes were critical to successful management, although the voices of fathers in this context may be neglected.

Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis.

Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis. One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (Mage =4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (Mdays since diagnosis=29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis. Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress. Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self-efficacy and ultimately support the management of their child's diabetes.

Parents' views about healthcare professionals having real‐time remote access to their young child's diabetes data: Qualitative study

ObjectivesWe explored parents' views about healthcare professionals having remote access to their young child's insulin and glucose data during a clinical trial to inform use of data sharing in routine pediatric diabetes care.Research Design and MethodsInterviews with 33 parents of 30 children (aged 1–7 years) with type 1 diabetes participating in a randomized trial (KidsAP02) comparing hybrid closed‐loop system use with sensor‐augmented pump therapy. Data were analyzed using a qualitative descriptive approach.ResultsParents reported multiple benefits to healthcare professionals being able to remotely access their child's glucose and insulin data during the trial, despite some initial concerns regarding the insights offered into everyday family life. Key benefits included: less work uploading/sharing data; improved consultations; and, better clinical input and support from healthcare professionals between consultations. Parents noted how healthcare professionals' real‐time data access facilitated remote delivery of consultations during the COVID‐19 pandemic, and how these were more suitable for young children than face‐to‐face appointments. Parents endorsed use of real‐time data sharing in routine clinical care, subject to caveats regarding data access, security, and privacy. They also proposed that, if data sharing were used, consultations for closed‐loop system users in routine clinical care could be replaced with needs‐driven, ad‐hoc contact.ConclusionsReal‐time data sharing can offer clinical, logistical, and quality‐of‐life benefits and enhance opportunities for remote consultations, which may be more appropriate for young children. Wider rollout would require consideration of ethical and cybersecurity issues and, given the heightened intrusion on families' privacy, a non‐judgmental, collaborative approach by healthcare professionals.

Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research.

Purpose of ReviewThis review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions.Recent FindingsRates of type 1 diabetes (T1D) in young children (ages 1–7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child’s diabetes management.SummaryT1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.

Long-term Occupational Consequences for Families of Children With Type 1 Diabetes: The Mothers Take the Burden.

To investigate the occupational and financial consequences for parents following the onset of type 1 diabetes in their child. A questionnaire assessing occupational and financial situations before and in the first year after the onset of diabetes was distributed to all families with a child ≤14 years of age at diagnosis with a diabetes duration of at least 12 months in nine German pediatric diabetes centers. Data of 1,144 children (mean age at diagnosis 6.7 [3.6] years; 46.5% female) and their families were obtained. Mothers' occupational status reflected in paid working hours was significantly reduced in the first year after their child's diabetes diagnosis (P < 0.001). Overall, 15.1% of mothers stopped working, and 11.5% reduced working hours. Mothers of preschool children were particularly affected. Fathers' working status hardly changed (P = 0.75). Nearly half of the families (46.4%) reported moderate to severe financial losses. Compared with an earlier similar study in 2003, significant negative occupational consequences for mothers and financial burden on families remained unchanged in 2018 (P = 0.59 and 0.31, respectively). Mothers of young children with newly diagnosed diabetes experienced negative consequences in their occupational situation. This inequality for mothers can have long-term negative consequences for their mental health and future economic situation. There is an urgent need for action to reduce the burden on families and to provide professional, social, and regulatory support, especially for mothers of young children with diabetes.

Demographic and clinical characteristics of a population-based pediatric cohort of type 1 and type 2 diabetes in Western Australia (1999-2019).

To determine demographic and clinical characteristics of youth diagnosed with type 1 (T1D) or type 2 (T2D) diabetes aged ≤15 years from 1999 to 2019 in Western Australia, and examine time to first diagnosis of diabetes complications. A retrospective cohort study was conducted of patients identified from the population-based, prospective Western Australian Children's Diabetes Database and longitudinal data extracted for available demographic and clinical variables. Patients were followed from diagnosis to transition to adult services, death, or December 31, 2019. Cox proportional hazards regression models were used to analyse time to first diagnosis of hypertension, high cholesterol or microalbuminuria, after adjusting for sex, age at diagnosis, time period of diagnosis, hemoglobin A1c , and body max index Z-score. 2438 eligible patients were identified (2209 [91%] T1D: 229 [9%] T2D). The mean age at diagnosis was lower in patients with T1D (8.5 [±4.0] vs. 12.7 [±2.0] years). A higher proportion of patients with T2D were female (58% vs. 47%) and of Aboriginal ethnicity (59% vs. 2%). The median HbA1c (interquartile range) at diagnosis was lower 8.9% [6.7, 11.5] (74 mmol/mol [50, 102]) versus 11.6% [10.1, 13.3] (103 mmol/mol [87, 122]) and mean body max index Z-score higher (2.05 [±0.66] vs. 0.37 [±0.95]), in patients with T2D compared to T1D. Patients with T2D had a higher risk of hypertension, high cholesterol, and microalbuminuria (aHR 3.39 [95%CI:2.04, 5.63], 2.69 [95%CI:1.21, 5.98], and 19.79 [95%CI:10.99, 35.64] respectively).

Children's Diabetes Management Using the Internet of Things and Robot Assistants

Children's Diabetes Management Using the Internet of Things and Robot Assistants

Predictors of mood, diabetes-specific and COVID-19-specific experiences among parents of early school-age children with type 1 diabetes during initial months of the COVID-19 pandemic.

ObjectiveThe current study explored pre‐pandemic sociodemographics, medical characteristics, social/family support, and mood symptoms, and current COVID‐19 experiences as predictors of mood, positive/negative diabetes‐specific experiences, and COVID‐19‐specific distress among parents of children with type 1 diabetes during the COVID‐19 pandemic. We hypothesized that parents from marginalized backgrounds, youth with higher pre‐pandemic A1c and no CGM use, parents with lower pre‐pandemic social/family support and more pre‐pandemic mood/anxiety symptoms, and those with more negative COVID‐19 experiences would have more depressive symptoms, fewer positive and more negative diabetes‐specific experiences, and more COVID‐19‐specific distress during the initial months of the pandemic.Research Design and MethodsParticipants were parents of early school‐age children with type 1 diabetes (n = 100; 65% non‐Hispanic, white, 92% mothers, 75% married; M child age = 6.74 ± 1.59 years) who had completed a behavioral intervention trial ≥6 months ago and were re‐contacted in June/July 2020 to report on their COVID‐19 pandemic experiences and parent psychosocial outcomes. Pre‐pandemic parent mood/anxiety symptoms, family/social support, and children's medical characteristics (CGM use; M A1C = 8.17% ± 1.40%) were assessed M = 1.45 ± 0.59 years prior.ResultsMore pre‐pandemic social support predicted fewer depressive symptoms, more positive diabetes‐specific experiences, and less COVID‐19‐specific distress during the pandemic. More pre‐pandemic depressive symptoms predicted more depressive symptoms during the pandemic. More life disruptions due to the pandemic were associated with more negative diabetes‐specific experiences and more COVID‐19‐specific distress. Parents of color had more negative diabetes‐specific experiences.ConclusionsSocial support may be particularly important to assess and address through intervention. Pediatric diabetes care providers should monitor parent experiences in relation to children's diabetes management.ClinicalTrials.gov identifier: NCT02527525.

User-driven, open-source diabetes technology (special issue): Paediatric DIY APS.

Do-it-yourself artificial pancreas system (DIY APS) uses tailor-made open-source software technology and algorithms to achieve automated insulin delivery (AID) systems which are not commercialised or regulated1 . There is currently no guidance in the United Kingdom (UK) National Health Service (NHS) on the use of DIY APS in children and young people, nor are there any guidelines given by the UK General Medical Council or Royal College of Paediatrics and Child Health to assist healthcare professionals looking after children's diabetes.