Clinical and sociodemographic factors associated with the quality of life of children and adolescents with type 1 diabetes

Ramalho, Elisabeth Luisa Rodrigues; Sparapani, Valéria de Cássia; Barber, Rebecca Ortiz La Banca; Oliveira, Renata Cardoso; Nascimento, Lucila Castanheira; Collet, Neusa

doi:10.1590/1980-220X-REEUSP-2023-0195en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0195en copy

Clinical and sociodemographic factors associated with the quality of life of children and adolescents with type 1 diabetes^* * Extracted from the dissertation: “Fatores clínicos e sociodemográficos associados à qualidade de vida de crianças e adolescentes com diabetes mellitus tipo 1”, Universidade Federal da Paraíba, 2022.

Factores clínicos y sociodemográficos asociados a la calidad de vida de niños y adolescentes con diabetes tipo 1

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze clinical and sociodemographic factors associated with the health-related quality of life of children and adolescents with type 1 Diabetes Mellitus.

Method:

A quantitative, cross-sectional and analytical study, developed in a municipality in northeastern Brazil, between March and September 2021, with 81 children/adolescents with type 1 Diabetes Mellitus and their guardians/caregivers. A questionnaire containing sociodemographic and clinical variables and two quality of life instruments were used. Descriptive and inferential analysis was carried out.

Results:

Adolescents whose parents had a family income greater than a minimum wage had a lower prevalence of impaired quality of life when compared to those with a lower income. Adolescents with time since diagnosis of less than four years had a satisfactory quality of life, and children aged 8 to 12 years who self-administered insulin had a lower prevalence of high quality of life compared to those who did not.

Conclusion:

Adolescents with a family income of less than a minimum wage, diagnosis time of more than four years and children aged 8–12 who self-administer insulin need greater professional support to have a better quality of life.

DESCRIPTORS
Diabetes Mellitus; Type 1; Child; Adolescent; Quality of Life; Health Profile

Variables	Health–related quality of life		P	PR*	(95%) CI^§ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.
Variables	Low/very low n(%)	High/very high n(%)	P	PR*
Children from 2 to 4 years
Education
High school/higher education	4 (57.1)	3 (42.9)	0.500^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.6	0.3–1.1
Elementary school	2 (100.0)	–		1	–
Family income
>1 minimum wage	2 (28.6)	5 (71.4)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.4	0.3–6.2
≤1 minimum wage	1 (50.0)	1 (50.0)		1	–
Marital status
With a partner	6 (66.7)	3 (33.3)	–	–	–
Parents have DM
No	6 (66.7)	3 (33.3)	–	–	–
Have children other than child/adolescent with 1DM
No	1 (16.7)	5 (83.3)	0.226^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	2.5	0.5–12.9
Yes	1 (33.3)	2 (66.7)		1	–
Children from 5 to 7 years
Education
High school/higher education	1 (33.3)	2 (66.7)	0.486^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.4	0.1–2.4
Elementary school	3 (75.0)	1 (25.0)		1	–
Family income
>1 minimum wage	3 (50.0)	3 (50.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.5	0.2–1.1
≤1 minimum wage	1 (100.0)	–		1	–
Marital status
With a partner	4 (66.7)	2 (33.3)	0.429^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	–	–
Without a partner	–	1 (100.0)		–	–
Parents have DM
No	2 (50.0)	2 (50.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.7	0.2–2.7
Yes	2 (66.7)	1 (33.3)
Have children
No	1 (50.0)	1 (50.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.8	0.2–4.0
Yes	3 (60.0)	2 (40.0)		1	–
Children from 8 to 12 years
Education
High school/higher education	4 (26.7)	11 (73.3)	0.439^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.7	0.2–1.9
Elementary school	6 (40.0)	9 (60.0)		1	–
Family income
>1 minimum wage	5 (31.3)	11 (68.8)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.9	0.3–2.4
≤1 minimum wage	5 (37.5)	9 (64.3)		1	–
Marital status
With a partner	8 (33.3)	16 (66.7)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.0	0.3–3.5
Without a partner	2 (33.3)	4 (66.7)		1	–
Parents have DM
No	8 (33.3)	16 (66.7)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.0	0.3–3.5
Yes	2 (33.3)	4 (66.7)		1	–
Have children
No	5 (45.5)	6 (54.5)	0.425^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.7	0.6–4.7
Yes	5 (26.3)	14 (73.7)		1	–
Adolescents from 13 to 18 years
Education
High school/higher education	10 (43.5)	13 (56.5)	0.259^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.6	0.3–1.1
Elementary school	7 (70.0)	3 (30.0)		1	–
Family income
>1 minimum wage	12 (63.2)	7 (36.8)	0.049 ^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.5	0.3–1.0
≤1 minimum wage	10 (71.4)	4 (28.6)		1	–
Marital status
With a partner	13 (56.5)	10 (43.5)	0.259^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.6	0.3–1.1
Without a partner	7 (70.0)	3 (30.0)		1	–
Parents have DM
No	15 (51.7)	14 (48.3)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.0	0.4–2.9
Yes	2 (50.0)	2 (50.0)		1	–
Have children
No	3 (30.0)	7 (70.0)	0.141^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.5	0.2–1.3
Yes	14 (60.9)	9 (39.1)		1	–

Variables	Health–related quality of life		P	PR*	(95%) CI^§ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.
Variables	Low/very low n (%)	High/very high n (%)	P	PR*
Sex
Male	8 (53.3)	7 (46.7)	0.464^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.3	0.1–3.0
Female	6 (40.0)	9 (60.0)		1	–
Education
Elementary school	14 (46.7)	16 (53.3)	–	–	–
Participates in diabetes education group
No	14 (46.7)	16 (53.3)	–	–	–
Parents have DM
No	10 (41.7)	14 (58.3)	0.378^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.6	0.3–1.3
Yes	4 (66.7)	2 (33.3)		–	–
Clinical status at 1DM diagnosis
Hyperglycemia with signs and symptoms	12 (44.4)	15 (55.6)	–	–	–
Diabetic ketoacidosis	1 (50.0)	1 (50.0)	–	–	–
Other	1 (100.0)	–	–	–	–
Time since diagnosis
Up to 4 years	11 (52.4)	10 (47.6)	0.440^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.6	0.6–4.3
> 4 years	3 (33.3)	6 (66.7)
Result of glycated hemoglobin
≤7	3 (42.9)	4 (57.1)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.0	0.3–2.7
>7	7 (43.8)	9 (56.3)		–	–
Device used to apply basal insulin
50 IU insulin syringe	–	1 (100.0)	–	–	–
100 IU insulin syringe	1 (100.0)	–	–	–	–
Insulin syringe with 100 IU needle attached	–	2 (100.0)	–	–	–
Disposable pen	4 (50.0)	4 (50.0)	–	–	–
Rechargeable pen	9 (52.9)	8 (47.1)	–	–	–
Insulin bomb	–	1 (100.0)	–	–	–
Device used to apply bolus insulin
50 IU insulin syringe	–	1 (100.0)	–	–	–
Insulin syringe with 100 IU needle attached	–	2 (100.0)	–	–	–
Disposable pen	10 (50.0)	10 (50.0)	–	–	–
1 IU rechargeable pen	2 (50.0)	2 (50.0)	–	–	–
Insulin bomb	–	1 (100.0)	–	–	–
Has sites with visible or palpable lipohypertrophy
One site	5 (38.5)	8 (61.5)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.8	0.2–2.5
Two sites	2 (50.0)	2 (50.0)	–	–	–
Self-administers insulin
Yes	5 (29.4)	12 (70.6)	0.030 ^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.4	0.2–1.0
No	9 (69.2)	4 (30.8)	–	–	–
Counts carbohydrates
Yes	–	3 (100.0)	0.228^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	–	–
No	14 (51.9)	13 (48.1)	–	–	–
Performs physical activity
Yes	13 (46.4)	15 (53.6)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.9	0.2–3.9
No	1 (50.0)	1 (50.0)	–	–	–
How many times has been admitted to hospital due to hypoglycemia
None	14 (48.3)	15 (51.7)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	–	–
Once	–	1 (50.0)	–	–	–
How many times has been admitted to hospital due to hyperglycemia
None	15 (55.6)	12 (44.4)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.9	0.2–3.8
Once	1 (50.0)	1 (50.0)	–	–	–
How many times has been admitted to hospital due to ketoacidosis
None	14 (48.3)	15 (51.7)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; §95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	–	–
Once	–	1 (50.0)	–	–	–

Variables	Health–related quality of life		P	PR*	(95%) CI^§ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.
Variables	High/very high n (%)	Low/very low n (%)	P	PR*
Sex
Male	15 (78.9)	4 (21.1)	0.244^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.3	0.9–1.9
Female	15 (62.5)	9 (37.5)	–	1	–
Age group
12 to 15 years	8 (80.0)	2 (20.0)	–	1	–
16 to 18 years	21 (65.6)	11 (34.4)	0.659^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.82	0.5–1.2
Education
Elementary school	24 (75.0)	8 (25.0)
High school	6 (60.0)	4 (40.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.5	0.4–6.3
Higher education	–	1 (100.0)
Participates in diabetes education group
Yes	1(100.0)	–	–	1	–
No	29 (69.0)	13 (31.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.4	1.2–1.8
Parents have DM
No	27 (75.0)	9 (25.0)	–	1	–
Yes	3 (50.0)	3 (50.0)	0.329^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.5	0.7–3.4
Clinical status at 1DM diagnosis
Hyperglycemia with signs and symptoms	24 (70.6)	10 (29.4)
Diabetic ketoacidosis	4 (57.1)	3 (42.9)
Asymptomatic	2 (100.0)	–
Time since diagnosis
Up to 4 years	8 (47.1)	9 (52.9)	0.009 ^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.6	0.3–0.9
> 4 years	22 (84.6)	4 (15.4)	–	1	–
Result of glycated hemoglobin
≤7	6 (85.7)	1 (14.3)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.1	0.8–1.6
>7	22 (78.6)	6 (21.4)	–	1	–
Device used to apply basal insulin
50 IU insulin syringe	1 (100.0)	–
100 IU insulin syringe	–	3 (100.0)
Insulin syringe with 100 IU needle attached	–	3 (100.0)
Disposable pen	9 (75.0)	3 (25.0)
Rechargeable pen	19 (82.6)	4 (17.4)
Insulin bomb	1 (100.0)	–
Device used to apply bolus insulin
50 IU insulin syringe	1 (100.0)	–
100 IU insulin syringe	–	1 (100.0)
Insulin syringe with 100 IU needle attached	1 (33.3)	2 (66.7)
Disposable pen	23 (74.2)	8 (25.8)
1 IU rechargeable pen	4 (100.0)	–
0.5 IU rechargeable pen	–	1 (100.0)
Insulin bomb	1 (100.0)	–
Has sites with visible or palpable lipohypertrophy
One site	11 (61.1)	7 (38.9)	–	1	–
Two sites	3 (75.0)	1 (25.0)	0.999^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.2	0.6–2.4
Self-administers insulin
Yes	28 (70.0)	12 (30.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.1	0.5–2.4
No	2 (66.7)	1 (33.3)	–	1	–
Counts carbohydrates
Yes	6 (85.7)	1 (14.3)	–	1	–
No	24 (66.7)	12 (33.3)	0.412^† Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.3	0.9–1.9
Performs physical activity
Yes	27 (69.2)	12 (30.8)	–	1	–
No	3 (75.0)	1 (25.0)	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.2	0.1–7.2
How many times has been admitted to hospital due to hypoglycemia
None	29 (69.0)	13 (31.0)	–	1	–
Once	1 (100.0)	–	1.000^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	0.7	0.6–0.8
How many times has been admitted to hospital due to hyperglycemia
None	28 (71.8)	11 (28.2)	–	1	–
Once	2 (50.0)	2 (50.0)	0.572^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.4	0.5–3.9
How many times has been admitted to hospital due to ketoacidosis
None	29 (70.7)	12 (29.3)	–	1	–
Once	1 (50.0)	1 (50.0)	0.518^‡ Note: †Pearson’s chi-square; ‡Fisher’s exact test; *Prevalence Ratio; § 95% Confidence Interval; DM = Diabetes Mellitus; 1DM= Type 1 Diabetes Mellitus.	1.4	0.3–5.7

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E-mail: reeusp@usp.br

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[1] Corresponding author: Elisabeth Luisa Rodrigues Ramalho Rua Francisco Timóteo de Souza, 570, Anatólia 58051-117 – João Pessoa, PB, Brazil elisabeth.luisa@yahoo.com.br