Disclosures: Patton reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
August 04, 2021
3 min read

Hypoglycemia fear, family conflict influence HbA1c trends in children with type 1 diabetes

Disclosures: Patton reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Parent-reported hypoglycemia fear and diabetes-specific family conflict may predict HbA1c trajectories for children aged 5 to 9 years with recent-onset type 1 diabetes, according to findings published in Diabetic Medicine.

In an analysis of 106 families of children with type 1 diabetes, researchers observed parents with more hypoglycemia fear were less likely to have a child with a high stable or intermediate increasing HbA1c trajectory, whereas increasing scores for parent-reported diabetes-specific family conflict were associated with higher odds for high stable or intermediate increasing HbA1c.

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“While our results are preliminary due to the size and discovery nature of the data set, they may have important clinical and research implications,” Susana R. Patton, PhD, ABPP, director of the Center for Healthcare Delivery Science at Nemours Children’s Health System, and colleagues wrote. “Clinically, our results suggest the possibility of new subgroups of children with recent-onset type 1 diabetes based on distinct HbA1c trajectories. This may provide an evidence base for tailoring more intensive diabetes education and therapies to families of children at the highest risk for an increasing or high stable HbA1c trajectory.”

Determining HbA1c trajectories

Researchers analyzed data from a prospective, longitudinal project at two pediatric diabetes centers in the Midwest and Rocky Mountain regions of the United States. Children aged 5 to 9 years within 12 months of a diabetes diagnosis and their families were recruited in clinic and by phone. Data were collected every 3 months or during routine clinic visits for up to 30 months after enrollment. At baseline, parents reported demographics and completed the Problem Areas in Diabetes Survey-Parent Revised to measure diabetes distress, the Hypoglycemia Fear Survey for Parents to measure hypoglycemia fear, the Center for Epidemiological Studies Diabetes Scale to measure depression symptoms, and the Diabetes Family Conflict Scale-Revised to measure perceptions of family conflict. HbA1c was collected from child participants at each study visit, with an HbA1c of 7.5% identified as the target.

There were 106 children and their parents who participated in the study. Children were categorized into one of four HbA1c trajectories. The high increasing trajectory included children with the largest positive HbA1c slope and high variability and had about 71% of HbA1c values above target (n = 8). The high stable trajectory included children with minimal change and variability in HbA1c, with an average of 90% of HbA1c values above target (n = 41). The intermediate increasing trajectory included those with a modest positive slope and variability in HbA1c and an average of 81% of HbA1c values above target (n = 30). The low stable trajectory had low HbA1c variability and only 32% of HbA1c values above target (n = 27).

HbA1c trajectories and parent psychosocial factors

Children were more likely to have a high stable HbA1c trajectory compared with the low stable trajectory for parents reporting more diabetes-related family conflict (beta = 0.81) and less likely to be in the high stable trajectory if parents reported more hypoglycemia fear (beta = –0.81). Children were also more likely to have an intermediate increasing HbA1c trajectory vs. a low stable trajectory if parents reported more diabetes-related family conflict (beta = 1.1) and less likely if parents had higher hypoglycemia fear scores (beta = –0.86).

“Our results associating children’s HbA1c-based trajectories to parents’ psychosocial variables may inform new interventions,” the researchers wrote. “For example, the associations we found between early parent-reported diabetes-specific family conflict total scores and future suboptimal child HbA1c levels and HbA1c trajectories suggest that families of young school-age children in the recent-onset period might benefit from education and adjunctive treatments targeting conflict.”

The researchers noted more parental hypoglycemia fear may increase a child’s odds for a low stable HbA1c trajectory, but other published studies do not support hypoglycemia fear as helpful for families long term.

“Thus, contrary to our results, we would propose that these findings also support a need for adjunctive interventions targeting parents’ fear and family conflict in the recent-onset period,” the researchers wrote.