Elsevier

The Journal of Pediatrics

Volume 161, Issue 2, August 2012, Pages 201-207.e2
The Journal of Pediatrics

Original Article
Demographic and Clinical Correlates of Diabetes-Related Quality of Life among Youth with Type 1 Diabetes

Preliminary results of this study were presented at the European Association for the Study of Diabetes Annual Meeting, Vienna, Austria, September 30, 2009 and the International Association of Pediatric and Adolescent Diabetes (ISPAD) Meeting, Miami, Florida, October 20, 2011.
https://doi.org/10.1016/j.jpeds.2012.01.016Get rights and content

Objectives

To evaluate the reliability and cluster structure of the Pediatric Quality of Life Inventory Type 1 Diabetes Module 3.0 (PedsQL-T1DM) and associated subscales and to explore the associations between PedsQL-T1DM total score and demographic and clinical characteristics and clinical indicators among a large racially/ethnically diverse cohort of youth with type 1 diabetes.

Study design

Principal components analysis was conducted on responses from the PedsQL-T1DM child self-report forms completed by SEARCH for Diabetes in Youth study participants aged ≥5 years. Multivariate linear regression models were fit to examine the associations among PedsQL-T1DM total score, demographic and clinical characteristics, and clinical indicators.

Results

The sample comprised 2602 youth with a mean age of 13.6 ± 4.1 years and a mean T1DM duration of 62.1 ± 47.0 months. Principal components analysis did not support the 5 existing PedsQL-T1DM subscales. In multivariate analyses, the PedsQL-T1DM total score was negatively and significantly associated with younger age (5-7 years), female sex, receiving insulin by injection (vs pump), having parents without a college degree, Medicaid/Medicare insurance, and having a comorbid medical condition. Youth with poor glycemic control based on their age-specific hemoglobin A1c target values and those with depressive symptoms had significantly lower PedsQL-T1DM scores than their counterparts with good control and no or limited depressive symptoms.

Conclusion

This study has identified sociodemographic and clinical characteristics of youth with T1DM more likely to experience poor diabetes-specific quality of life. The association of lower PedsQL-T1DM scores with depressive symptoms and poor glycemic control is especially concerning and may be the focus of future interventions and studies.

Section snippets

Methods

SEARCH is a multicenter study that in 2001 began conducting population-based ascertainment of youth diagnosed with T1DM at age <20 years.8 SEARCH recruited youth from 4 geographically defined populations, Indian Health Service beneficiaries from 4 American Indian populations, and enrollees in several managed health care plans. Institutional review board(s) for each site approved the study protocol. All registered cases were asked to complete a brief initial survey; survey respondents were

Results

The study sample comprised 2602 youth (mean age, 13.6 ± 4.1 years) who had T1DM for a mean duration of 62.1 ± 47.0 months and had a mean HbA1c value of 8.5% ± 1.6%. Three-quarters were non-Hispanic white, 50% were male, and ≈80% had a parent with at least some college education and were privately insured. Approximately half of the youth in the cohort used multiple daily insulin injections, and 22% used an insulin pump.

Discussion

We found that the 5 original subscales of the PedsQL-T1DM module were not supported by our PCA. A 5-cluster solution explained only ∼43% of the total variation among item responses. Our conclusions are consistent with those of Nansel et al,21 who conducted a similar analysis on responses from 447 youth with T1DM using PCA with a promax rotation and concluded that the PedsQL-T1DM total score, but not the original subscales, was the most appropriate unit for analysis. Their 5-factor structure

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    Funding information is available at www.jpeds.com (Appendix 2). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors declare no conflicts of interest.

    A list of members of the SEARCH for Diabetes in Youth Study is available at www.jpeds.com (Appendix 1).

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