Journal
DIABETIC MEDICINE
Volume 36, Issue 8, Pages 1028-1036Publisher
WILEY
DOI: 10.1111/dme.13983
Keywords
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Categories
Funding
- Centers for Disease Control and Prevention [00097, DP-05-069, DP-10-001]
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases [1UC4DK108173]
- Kaiser Permanente Southern California [U18DP006133, U48/CCU919219, U01 DP000246, U18DP002714]
- University of Colorado Denver [U18DP006139, U48/CCU819241-3, U01 DP000247, U18DP000247-06A1]
- Cincinnati's Children's Hospital Medical Center [U18DP006134, U48/CCU519239, U01 DP000248, 1U18DP002709]
- University of North Carolina at Chapel Hill [U18DP006138, U48/CCU419249, U01 DP000254, U18DP002708]
- Seattle Children's Hospital [U18DP006136, U58/CCU019235-4, U01 DP000244, U18DP002710-01]
- Wake Forest University School of Medicine [U48/CCU919219, U18DP006131, U01 DP000250, 200-2010-35171]
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Aim To examine the distribution and association of sociodemographic, adherence, and barriers-to-care factors in relation to glycaemic control within insulin regimens in US children with Type 1 diabetes in the SEARCH for Diabetes in Youth Study. Methods Self- or parent-reported data from 1095 children with Type 1 diabetes aged 10-17 years were collected on insulin regimen, sociodemographics, diabetes self-management, diabetes-related family conflict and barriers to care. Multivariable logistic regression analysis identified poor glycaemic control correlates within each insulin regimen. Results Participants included 694 children on insulin pump therapy, 188 receiving basal-bolus injections, and 213 on a mixed insulin regimen. Of these, 28.5%, 45.2% and 51.2%, respectively, had poor glycaemic control [HbA(1c) >= 80 mmol/mol (9.5%)]. Family conflict between parent and child regarding diabetes management was the only factor significantly associated with poor glycaemic control in all insulin regimens (insulin pump, P <= 0.0001; basal-bolus injections, P=0.0002; mixed insulin regimen, P=0.0103). For children on insulin pump, poor control was significantly associated with non-white race (P=0.0008), living in multiple households (P=0.0331), having Medicaid insurance (P=0.0090), and decreased insulin adherence (P<0.0001). For children on a mixed insulin regimen, living in multiple households (P=0.0256) and not spending enough time with healthcare provider (P=0.0058) correlated with poor control. Conclusions A high percentage of US children with Type 1 diabetes had poor glycaemic control, especially those not using an insulin pump. Early identification of children with risk factors associated with poor glycaemic control within insulin regimens and addressing diabetes-related family conflict may allow interventions to improve diabetes management.
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