Psychosocial determinants of glycaemic control in children and adolescents with Type One Diabetes Mellitus

Abstract

Introduction Type 1 Diabetes Mellitus (T1DM) is a chronic life-long condition that commonly presents in children and adolescents. It is a condition that requires close monitoring, as poor management may lead to severe complications later in life. Psychosocial factors are an aspect that must be considered when making management plans, as it can impact health outcomes for these individuals. This study aims to explore three psychosocial measures: Chaos Hubbub and Order Scale (CHAOS); Intuitive Eating; and temperament/self-control, in children and adolescents with T1DM, and investigate any relationship between these measures and their glycaemic control. In doing so, we hope to contribute to the growing body of literature aiming to improve glycaemic control in children and adolescents with T1DM. Methods This was a cross sectional study involving 74 eligible families of children/adolescents with T1DM. The Child/adolescent were required to be between ages 3-18 and had to be out of their honeymoon phase (> 0.5 units of insulin per kg per day). Each parent (both maternal and paternal) were asked to fill out a demographic questionnaire, a CHAOS questionnaire, self-reported Adult Temperament Questionnaire and an age appropriate Temperament Questionnaire on their child. The Child/adolescent were asked to also fill-out a demographic questionnaire, participate in the Heads knees shoulders and Toes (HKST) test, and fill out an Intuitive Eating Scale if they were above the age of 12. HbA1c was used as a measure of glycaemic control. An age and sex matched control group was recruited through participating families and the University of Otago’s Psychology Database. These Control families were not required to participate in the HKST test nor the Temperament questionnaire. Results Maternal CHAOS (MCHAOS) and Paternal CHAOS (PCHAOS) were both negatively associated with HbA1c after controlling for age, self-monitoring of Blood Glucose (SMBG), insulin therapy and Body Mass Index (for paternal only). The Odds Ratio generated by the multivariate model for MCHAOS and PCHAOS with HbA1c, was 1.30 (95% CI: 1.02 – 1.65) and 1.28 (95% CI: 1.01 – 1.62) respectively. MCHAOS showed limited utility as a tool to detect poor or acceptable glycaemic control with a sensitivity and specificity of 52.9% (95% CI: 35.10 – 70.20%) and 85.7% (95% CI: 67.30 – 96.00%), respectively. However PCHAOS showed potential to be used as a screening tool with a sensitivity and specificity of 92% (95% CI: 74 – 99%) and 37.5% (95% CI:18.80 – 59.4%), respectively. No statistically significant difference was observed between MCHAOS of families with T1DM (mean: 18.02) and their controls (17.40) with a 95% confidence interval for the t-test of -0.341 – 1.581. additionally, PCHAOS was reported to be significantly higher in T1DM (mean: 18.51) than controls (mean: 17.25) with a 95% confidence interval for the t-test of 0.052 – 2.468. Out of the four scales of intuitive eating, Eating for physical rather than emotional reasons, was found to be negatively associated with HbA1c with an odds ratio of 0.27 and a 95% CI ranging from 0.08 – 0.85. No significant difference was found in measures of intuitive eating between adolescents with T1DM and their matched controls. Maternal and Paternal report of Child effortful control were both negatively associated with HbA1c after controlling for age, SMBG, insulin therapy and BMI (for paternal and paternally reported child measures only). Maternally and paternally reported child effortful control had an odds ratio of 0.42 (95% CI: 0.20 – 0.89) and 0.21 (95% CI: 0.06 – 0.71)respectively. Maternally reported child attention was also negatively associated with HbA1c (Odds Ratio:0.44, 95% CI: 0.22 – 0.91), with paternally reported child attention approaching significance (p-value of 0.08). In addition, self-reported maternal activity and attention were both found to be negatively associated with HbA1c, even after controlling for age, SMBG and Insulin Therapy. The odds ratio for Maternal activity and attention were 0.36 (95% CI: 0.17 – 0.78) and 0.43 (95% CI: 0.21 – 0.87) respectively. The HKST test failed to show any significant relationship with HbA1c. With a median score of 57 out of 60, it was found to be inappropriate for this age group. Conclusion: This is the first study to investigate the concept of intuitive eating and CHAOS in Type One diabetes mellitus. We have provided evidence indicating that these measures are predictors of HbA1c, and paternal CHAOS in particular, has clinical potential to aid the process of identifying populations at risk of poor glycaemic control. The present study is also the first study to use the Mary Rothbart’s Temperament scales in this population, and has found that child effortful control (Cognitive regulation) is associated with good glycaemic control. In addition to this, maternal measures of temperament, in particular activity and attention levels were also found to be predictors of glycaemic control. This study has explored three novel psychosocial tools in diabetes, and provides preliminary evidence warranting further research in these areas.