Family conflict could negatively impact type 1 diabetes control in children

[DCUK NewsBot]

Family conflict related to diabetes management can negatively impact the blood glucose control of a child with type 1 diabetes, researchers have found. In what has been dubbed the "largest type 1 diabetes cohort examination of diabetes-related family conflict", US researchers wanted to investigate some of the issues which might impact blood glucose control in young people. The SEARCH for Diabetes in Youth study involved recording data from 1,095 children aged between 10-17 who all had type 1 diabetes. The research team looked at insulin regimes, sociodemographics and certain barriers that may be problematic to achieving positive healthcare outcomes. Lydia Snyder, from the Nemours Children's Health System, Florida, said: "Implementation of interventions to reduce diabetes-related family conflict is important given it is one of the potentially modifiable factors in the home environment that could significantly improve diabetes care management." The researchers reviewed the factors across three different types of insulin therapy. The proportion of children with high HbA1c levels - 80 mmol/mol (9.5%) or greater - were 28.5% of children on insulin pump therapy, 45.2% of those on basal-bolus injections and 51.2% for those on a mixed insulin regimen. These results show that a high percentage of US children that were not using an insulin pump showed significant signs of difficulty with controlling blood glucose levels. Further analysis showed that parent-related conflict relating to the child's condition was the only factor that negatively impacted blood glucose levels within all of the methods of insulin therapy. The researchers concluded that improvement of type 1 diabetes control may be achievable through early identification of children with risk factors associated with high HbA1c and through addressing diabetes‐related family conflict. The findings have been published in the Diabetic Medicine journal.

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[kitedoc]

Apart from stating the obvious: that stress can affect diabetes control, what is not ststed is that ADA recommendations for BSL level in adults and children/ teenagers are set higher the in some other countries, the underlying likely reason? Paediatricians and diabetes ohysuicians are worried about getting sued if the oatient suffers from a hypo, so setting the recommended BSLs higher helps avoid this. And possibly it is mire difficult to sue for diabets complications showing uo years later.
On a pump yes, control could be less disturbed by stress on some loop system but if Medtronic's bsl range is anything to go by Up to 9 mmol/l ( 9 x 18 mg/dL) is acceotable.
Furthermore where couples are separated, sometimes a paediatrician has obtained a court order specifying that the child/ teenager has to demonstrate insulin doses on pump consistent with a hi carb diet.
This despite the best control with least hypos for children who adopt a very low carb diet. (Ludwig et al).