Feeding problems reported by parents of young children with type 1 diabetes on insulin pump therapy and their associations with children’s glycemic control

Managing diabetes in young children presents many challenges. From a physiological perspective, reports demonstrate that young children with type 1 diabetes are often highly insulin sensitive, potentially complicating the regulation of children’s blood glucose levels (1). Moreover, developmentally, young children with type 1 diabetes often demonstrate increased independence seeking, transient food preferences, behavioral resistance, and volatile emotions, which can affect adherence to treatment (2, 3). Parents bear the primary responsibility for managing diabetes in a young child, including monitoring children’s blood glucose levels, administering insulin, and guiding children’s diet and food intake (1). Thus, research examining parent-child behaviors may offer important information for targeting interventions to achieve optimal diabetes management in young children with type 1 diabetes. Most of the research examining parent-child behaviors at mealtimes has primarily recruited young children on a conventional insulin regimen. These studies have shown that parents of young children frequently report problems with mealtimes and adherence to a strict daily diet plan for carbohydrate intake (2, 4). Moreover, these studies have found associations between poor parent-child mealtime behaviors and poor dietary adherence and glycemic control in these children (5, 6). Recently, intensive insulin management has become more popular for young children with type 1 diabetes (1, 7, 8). Because of the greater frequency of insulin injections and the ability to titrate insulin doses to children’s actual carbohydrate intake, intensive insulin management is hypothesized to more closely mimic normal pancreatic function and to simplify diabetes management for families (9). Children no longer have to follow a strict diet plan for the timing of meals and carbohydrate intake. Moreover, for young children using an insulin pump, extra doses of insulin do not require additional injections. It is expected that intensive insulin therapy allows for the young child with type 1 diabetes to eat more normally, which may reduce the burden on parents to impose structure at mealtimes to ensure adequate carbohydrate intake. However, there is no research examining mealtime behaviors and parent feeding strategies in families of children with type 1 diabetes who are intensively managed. This study examined parent-report of mealtime behaviors in a sample of young children with type 1 diabetes on insulin pump therapy and compared them to published data of young children on a conventional regimen and children without diabetes (2). In addition, the current study examined the associations of two valid parent-report measures of child feeding behavior with children’s average glycemic control. This study tested the following hypotheses: Caregivers of young children with type 1 diabetes using an insulin pump would report lower rates of child mealtime behavior problems and parental difficulties with mealtime management compared to published data from caregivers of conventionally-managed young children. Caregivers of young children with type 1 diabetes using an insulin pump would report low rates of parental restriction and pressuring children to eat. Among caregivers of young children who report parental restriction of child feeding and problems with mealtime behavior, there will be positive associations between these variables and children’s average glycemic control.