The Relationship Between Hemoglobin A1C in Youth With Type 1 Diabetes and Chaos in the Family Household
Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Levin, Dr Polfuss). The Diabetes Educator
(Impact Factor: 1.79).
08/2013; 39(5). DOI: 10.1177/0145721713496872
PurposeThe purpose of the study was to examine how physical and social environments, as measured by household chaos, affect the diabetes control (ie, A1C) in youth with type 1 diabetes (T1DM).Methods
One hundred and four patients (53 male, 51 female) with T1DM (aged 1-13 years) and their caregivers were recruited from a diabetes clinic at a Midwestern children's hospital. The caregivers completed a demographic questionnaire as well as a questionnaire pertaining to chaos in the household. A medical record review at baseline and 3- and 6-month follow-up was also conducted.ResultsResults found that above and beyond the demographic covariates, there still remained a significant relationship between household chaos and glycemic control. Those who scored more than 1 standard deviation above the mean Confusion, Hubbub, and Order Scale (CHAOS) measure score showed significantly worse glycemic control at 6-month follow-up.Conclusions
This study demonstrated the relationship of family environment and glycemic control for youth with T1DM. The findings highlight the need to individually assess the youth's home environment to promote diabetes management and care during clinic visits.
Available from: Ronny Geva
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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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ABSTRACT: Despite advances in the medical management of type 1 diabetes mellitus (T1DM), for many, glycaemic control remains substandard. Other factors are clearly important in determining success, or lack thereof, with diabetes management. With this in mind, we have investigated whether family CHAOS may provide a novel tool to identify when environmental confusion could impact on diabetes management and subsequent glycaemic control.
A case-control study of children and adolescents with established T1DM and age-/sex-matched controls was conducted. Demographic information, both maternal and paternal CHAOS scores, and HbA1c were collected. Statistical analysis was undertaken to explore associations between T1DM and CHAOS and between CHAOS and HbA1c.
Data on 65 children with T1DM and 60 age-/sex-matched controls were obtained. There was no evidence of group differences for maternal CHAOS (p = 0.227), but paternal CHAOS scores were higher for the T1DM group (p = 0.041). Greater maternal and paternal CHAOS scores were both associated with higher HbA1c (p ≤ 0.027). The maternal association remained after controlling for diabetes duration, SMBG frequency, and insulin therapy.
In children with T1DM, there appears to be a negative association between increased environmental confusion, as rated by CHAOS, and glycaemic control. In addition, when compared to controls, fathers of children and adolescents with T1DM appear to experience CHAOS differently to mothers. These findings contribute to the growing body of literature exploring psychosocial factors in T1DM. Continuing efforts are required to fully understand how the family and psychosocial environment interact with diabetes to impact on long-term health outcomes.
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ABSTRACT: Important stakeholders, including the American Diabetes Association (ADA) and the International Society of Pediatric and Adolescent Diabetes (ISPAD), recognize the need for psychologists to be an integral part of diabetes care. This review paper aims to provide a comprehensive examination of pediatric psychologists' roles in working with children and adolescents with diabetes, including during distinct phases of treatment (e.g., diagnosis, outpatient diabetes clinic visits, inpatient hospitalizations, and outpatient psychology visits) and with different modalities of psychological interventions (e.g., screening, individual, family, and group therapy). In addition, the role of the psychologist in diabetes care within various settings (e.g., private practice, academic medical centers, and community organizations) will be explored. Finally, this paper will outline other roles in which psychologists contribute to diabetes-specific efforts (e.g., translational research, program development in transition to adult care, advocacy for health care reform initiatives, health care billing/reimbursement, and alternative methods to psychosocial care delivery) as well as future directions for working with children and adolescents with diabetes. Pediatric psychologists have multiple professional roles in a wide variety of settings; however, there is more that can be done in the future to fully utilize pediatric psychologists in diabetes care for children and adolescents, such as embedding psychologists into integrated clinic visits where families receive comprehensive medical and psychological services to support overall health and well-being. Therefore, there is a need for increased advocacy to obtain even more pediatric psychology engagement in diabetes care to provide new clinical services and develop more translational research.
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