Parental Management of Young Children's Diabetes
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional

Summary: 
      Type 1 diabetes is a lifelong metabolic disorder that affects 1 out of every 400-600 American
      children each year, with many children being diagnosed at younger and younger ages.

      To achieve proper diabetes control, it is necessary to conform or adhere one's behavior to a
      physician-prescribed diabetes self-care regimen. As such, parents of children with Type 1
      diabetes must be highly involved in managing their child's disease on a daily basis,
      especially parents of affected children who are very young and more highly dependent upon
      parental caretaking.

      As children diagnosed with Type 1 diabetes at a very young age may be at an increased risk
      for the development of long-term behavioral and medical complications, more research is
      needed to understand and treat the leading contributors to diabetes-related parental distress
      and medical outcomes among this growing subgroup.

      Recent findings indicate that responsibility for diabetes management falls heavily on
      mothers. The majority of families do not receive outside child care assistance and report
      feeling overwhelmed. Parents report high levels of pediatric parenting stress difficulty, as
      well as moderate symptoms of anxiety. The current study aims to expand such preliminary
      findings and specifically examine the effects of a newly-developed parenting support program
      for parents of young children with Type 1 diabetes. The utility of the intervention will be
      evaluated. It is hypothesized that parents completing the parent support program will report
      lower levels of psychosocial distress and improved quality of life. It is hypothesized that
      the children of participating parents will also demonstrate improved quality of life and
      metabolic control.
    

Detailed description: 
      Type 1 diabetes is a lifelong metabolic disorder that affects 1 out of every 400-600 American
      children each year, with many children being diagnosed at younger and younger ages. If Type 1
      diabetes is not properly controlled, it can lead to a host of devastating disease-related
      complications later in life. Therefore, achieving proper diabetes control during childhood is
      an important public health issue.

      To achieve proper diabetes control, it is necessary to conform or adhere one's behavior to a
      physician-prescribed diabetes self-care regimen consisting of multiple insulin
      administrations and blood glucose (BG) checks daily, as well as pay careful attention to diet
      and exercise. As such, parents of children with Type 1 diabetes must be highly involved in
      managing their child's disease on a daily basis, especially parents of affected children who
      are very young and more highly dependent upon parental caretaking.

      It is not surprising that the experience of managing a child's diabetes can be demanding,
      overwhelming, and stressful for some parents, and may even significantly impair parental
      psychosocial well being. Further, difficulties achieving proper diabetes control have been
      reported to occur among parents of children of all ages, including parents of those who are
      very young.

      Operationally, these psychosocial well being and diabetes outcomes can be examined by
      assessing: (1) parental symptoms of depression, anxiety, diabetes parenting stress, and
      perceived social support, and (2) metabolic control, which may be measured with the quarterly
      HbA1C counts.

      As children diagnosed with Type 1 diabetes at a very young age may be at an increased risk
      for the development of long-term behavioral and medical complications due to the
      aforementioned difficulties (on the part of their parents), more research is needed to
      understand and treat the leading contributors to diabetes-related parental distress
      (depression, anxiety, stress, social support) and medical outcomes among this growing
      subgroup.

      Recent findings indicate that responsibility for diabetes management falls heavily on
      mothers, who report performing 79% of their children's injections and 70% of blood glucose
      checks (Mednick, 2005). The majority of families do not receive outside child care assistance
      and report feeling overwhelmed. Parents report high levels of pediatric parenting stress
      difficulty, as well as moderate symptoms of anxiety. The current study aims to expand such
      preliminary findings and specifically examine the effects of a newly-developed parenting
      support program for parents of young children with Type 1 diabetes. The utility of the
      intervention will be evaluated. It is hypothesized that parents completing the parent support
      program will report lower levels of psychosocial distress and improved quality of life. It is
      hypothesized that the children of participating parents will also demonstrate improved
      quality of life and metabolic control.

      Evaluating this intervention is a first step in the long-term goal of improving diabetes
      health outcomes for young children. Understanding the usefulness of this intervention can
      help us to further refine intervention programs for parents of young children with Type 1
      diabetes that best meet their unique needs and risks.
    

Intervention name(s): Parental Support; Diabetes Education
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention utilizes cognitive behavioral strategies. Session 1 uses relaxation and cognitive reframing and explores parents' responses to the challenges of parenting a child with diabetes. Session 2 focuses on the emotional impact of having a child with diabetes and utilizes problem solving techniques. Session 3 focuses on child behavior and strategies for effective parenting. To facilitate support and community, Session 4 is a group session via conference call to discuss issues related to social support. Session 5 focuses on the impact diabetes has on the family and parents are taught cognitive reframing to help with managing diabetes. Parents are invited to participate in an Internet bulletin board moderated by trial personnel.; The education comparison group also participates in 5 sessions across 9 weeks. This group provides educational and resource support that is specific to managing diabetes in young children. Education topics include blood glucose monitoring, nutrition, and physical activity. Print materials are provided to participants and intervention sessions focus on talking points raised in these reading materials.
Other intervention name(s): Cognitive Behavioral Strategies; Parent Support; Diabetes Management; Nutrition; Exercise
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Type 1 Diabetes; Parenting; Young Children