Personal and Clinical Predictors of Poor Metabolic Control in Children with Type 1 Diabetes in Jordan

Abstract

Background. Achieving adequate metabolic control in children with type 1 diabetes is important in slowing the progression of future microvascular and macrovascular complications, but still it is a universal challenge. We aim to investigate possible factors associated with poor metabolic outcomes in Jordan as an example of a country with limited resources. Methods. This is a retrospective chart review study of children with type 1 diabetes. Several clinical and personal characteristics were tested for association with metabolic control reflected by HbA1c levels. Linear logistic regression analysis was used to evaluate possible predictors of metabolic control. One-way ANOVA analysis was used to detect significant differences in HbA1c between categories. Results. Significant predictors of metabolic control were found. A one-year increase in age led to an increase in HbA1c by 0.053% (P=0.044). A decline in HbA1c levels was predicted in children who have precise amount of carbohydrates or who are receiving insulin at school (-0.46% (P=0.014) and -0.82% (P=0.004), respectively). When family members other than mothers decided the insulin dose, the HbA1c level increased by 0.74% (P=0.005). Conclusion. Poor metabolic control was associated with age, dietary noncompliance, not receiving insulin at school, and absence of direct mother care. Our study is one of the few studies from Middle East evaluating predictors of metabolic control. Global research studies help in giving universal insight towards developing more effective multidisciplinary team approach for diabetes care and education.

Time to First Optimal Glycemic Control and its Predictors Among Type 1 Diabetic Children<15 Years in Bahir Dar City Public Referral Hospitals, North West Ethiopia: A Retrospective Follow Up Study

“…In regard to predictors, the age of the participant was found to be signi cantly associated variables that determine time to rst optimal glycemic control. The study showed that, the time needed to reach rst optimal glycemic control is longer among clients of age group >10-14 years followed by the age group 6-10 years compared to clients in the age group<=5 years(AHR=0.324,95%CI=0.192-0.546), indicating that for children older than 10 years, the rate of achieving optimal glycemic control decreases as age increases which is in line with study done in Tanzania ,Bulgaria, Iraq, Taiwan and Jordan (26,46,47,49,50). This can be due to the fact that As a child develops, he/she under goes a varieties of physical and life style changes (24).…”

“…Especially those clients whose care giver mother and father was two times more likely associated with rst optimal glycemic control as compared with clients supported by their mothers alone. The nding was supported by the study conducted in Tanzania and middle east Jordan (32,50).…”

“…Sample size was determined by double proportion formula after taking of predictors associated to optimal glycemic control from previous study conducted by retrospective cohort design (50)with the help of epi info version 7 by considering the following statistical assumptions: 95% Con dence Interval (CI), power 80%,percent of outcome in unexposed group 8.93%,risk ratio 0.253, marginal error 5% (50) .The calculated total sample size is 378, then by adding 10% for data incompleteness from the client chart, the nal sample size became 416.…”

Association of family structure with type 1 diabetes management and outcomes in adolescents: A population‐based cross‐sectional survey

“…According to Baumer et al preplanned outpatient appointments were less likely to have been attended if a child did not live with both parents (78.8% vs. 83.7%, p < 0.001), indicating temporal constraints of single parents 35 . Other explanatory approaches may include difficulties in providing, supervising and monitoring diabetes management (i.e., regarding the SMBG frequency, meals and snacks) 20,36 ; a diabetes caregiver other than the mother 37 ; health literacy 38 ; prevalence of life stressors 36 ; and family dynamics, such as cohesion, support, and conflict 20,39 …”

Glycemic Control in a Cohort of children with type1 Diabetes Mellitus in Sulaimanyah City

“…This is because type 1 diabetes puts high demand on parents to learn multiple management skills, further on, basic levels of education is needed to know the importance of compliance and the consequences of poor control on long term complications, while knowing how to use more advanced technologies demands even higher skills, this finding is in coherence with other studies on the subject. 12,[19][20][21] Also within this context, a study involving 3 pediatric diabetic center in United Kingdom, showed that social deprivation, was associated with the least likelihood of initiation or success in intensive insulin therapy, a factor likely to contribute to poor diabetic control, this seemed to be mediated through lower educational levels. 22 In agreement with other studies, this study found that diabetic control was poorer in older pediatric age groups, this could partially be due to the surges in growth and sex hormones, and the psychological difficulties in adolescence causing less compliance and increased insulin resistance.…”