Implications of the School Day on Health Behaviors for Children With Type 1 Diabetes: A Survey of Parent Perspectives During the COVID-19 Pandemic

Abstract

Purpose The purpose of this study is to survey parents of youth with type 1 diabetes during the COVID-19 pandemic with school closures to better understand the implications of the school day on health care behaviors. Methods A cross-sectional, online survey was distributed to parents of youth with type 1 diabetes ≤19 years of age in a large, academic diabetes center. Questions encompassed perceived changes in management behaviors and plans for return to school. Subgroup analysis compared parent responses by child’s age, reported stressors, and socioeconomic markers. Results Parents reported a worsening in their child’s diabetes health behaviors during school closures compared to what they perceived during a regular school day before the pandemic. More than half of parents reported feeling that their child was unable to maintain a normal routine, with particular implications for snacking between meals, daily physical activity, and sleep habits. Families with adolescents or those experiencing multiple pandemic-related stressors reported greater challenges. In open-ended responses, families highlighted difficulty in balancing school, work, and diabetes care and expressed concerns about the mental health repercussions of school closures for their children. Nearly half of parents reported being at least moderately worried about return to school, whereas only a minority reported seeking guidance from their diabetes provider. Conclusions Parent-reported disruptions of school-day routines frequently had adverse consequences for diabetes management in this population. These findings highlight the importance of a school-day routine for children with type 1 diabetes; during closures, families may benefit from mitigating strategies to maintain effective habits.

Impacts of the COVID-19 Pandemic on Pediatric Type 1 Diabetes Management: A Qualitative Study

“…Although parents overwhelmingly reported that management of their child’s T1DM was easier during the COVID-19 pandemic, reduced physical activity and increased sedentary time were consistently described as key diabetes management challenges. This is consistent with an accumulating body of evidence in children, young adults, and adults with diabetes highlighting reductions in physical activity 6 , 9 - 11 , 20 , 22 - 25 , 31 and increases in screen time 11 , 31 during the COVID-19 pandemic. Given that health risks associated with excess screen time include poor sleep, insulin resistance, and cardiovascular disease, 32 marked increases in screen time during the pandemic are particularly concerning for children with T1DM, who are at a higher risk of cardiovascular disease compared to those without diabetes.…”

“…These perceived improvements in glycemic control are consistent with findings of recent studies conducted among children and adults with T1DM during the COVID-19 pandemic in other countries, 19 such as Italy, 8 - 10 , 19 , 20 , Spain, 19 the United Kingdom, 19 and Malaysia. 11 However, literature remains mixed 19 because several other studies, including those conducted in the United States, 6 , 21 Saudi Arabia, 22 Japan, 23 India, 24 and Italy, 25 reported either poorer glycemic control or no significant change during the pandemic.…”

“…Another noteworthy finding was the negative impacts of the pandemic on both the parents’ and their children’s mental health. While adverse psychological implications of COVID-19 lockdowns and school closures have been widely reported, 1 , 2 , 6 , 22 , 34 parents explained that having a child with T1DM further exacerbated their own psychological distress. Parents described anxiety about their child contracting COVID-19 due to diabetes being a risk factor for severe COVID-19 morbidity and mortality.…”

“…3 For parents, managing their child’s T1DM is often associated with high reported levels of stress and anxiety. 4 The COVID-19 pandemic may have amplified these stressors due to COVID-19-related job loss and financial concerns, 5 , 6 the child being at higher risk of a severe COVID-19 infection, 7 and the added burden of managing their child’s diabetes in light of new responsibilities associated with the pandemic. 5 , 6 …”

“…3 For parents, managing their child's T1DM is often associated with high reported levels of stress and anxiety. 4 The COVID-19 pandemic may have amplified these stressors due to COVID-19-related job loss and financial concerns, 5,6 the child being at higher risk of a severe COVID-19 infection, 7 and the added burden of managing their child's diabetes in light of new responsibilities associated with the pandemic. 5,6 In addition, these restrictions may also challenge adherence to key aspects of diabetes management, such as participating in physical activity due to cancellation of organized sports and school closures.…”