title: Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views.
abstract: OBJECTIVE
  To explore the difficulties parents encounter in trying to achieve clinically recommended blood glucose levels and how they could be better supported to optimize their child's glycaemic control.
  
  
  METHODS
  In-depth interviews were conducted with 54 parents of children with Type 1 diabetes (≤ 12 years). Data were analysed thematically.
  
  
  RESULTS
  Parents described being reluctant and finding it difficult to keep their child's blood glucose levels consistently within clinically recommended ranges. As well as worrying about their child's ability to detect/report hypoglycaemia, parents highlighted a multitude of factors that had an impact on their child's blood glucose levels and over which they could exercise little control. These included: leaving their child with other caregivers who could not be trusted to detect hypoglycaemia; difficulties remotely monitoring and regulating their child's food consumption and activity; and physical and social changes accompanying childhood development. Most parents used two sets of blood glucose targets, with clinically recommended targets employed when their child was in their immediate care and higher targets when in the care of others. Parents described health professionals as lacking understanding of the difficulties they encountered keeping blood glucose within target ranges and needing more empathetic, tailored and realistic advice.
  
  
  CONCLUSIONS
  It is not parents' fear of hypoglycaemia in isolation that leads to decisions to raise their child's blood glucose but, rather, parental fear in conjunction with other factors and considerations. Hence, to improve diabetes management in children, these factors may need to be addressed; for instance, by training others in diabetes management and using new technologies. Changes to consultations are also recommended.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh.
authors.forename: J
authors.initials: J
authors.lastname: Lawton
authors.affiliation: Health Sciences, Division of Health Sciences Warwick Medical School, University of Warwick, Coventry.
authors.forename: N
authors.initials: N
authors.lastname: Waugh
authors.affiliation: Human Development and Health, University of Southampton, Southampton General Hospital, Southampton.
authors.forename: K D
authors.initials: KD
authors.lastname: Barnard
authors.affiliation: Royal Hospital for Sick Children, Edinburgh.
authors.forename: K
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh.
authors.forename: J
authors.initials: J
authors.lastname: Harden
authors.affiliation: Child Health Department, Borders General Hospital, Melrose.
authors.forename: J
authors.initials: J
authors.lastname: Stephen
authors.affiliation: Nursing and Health Care School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: J
authors.initials: J
authors.lastname: McDowell
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh.
authors.forename: D
authors.initials: D
authors.lastname: Rankin
mesh_terms: D000328:Adult; D001007:Anxiety; D001294:Attitude to Health; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D005239:Fear; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010290:Parents; D036301:Qualitative Research
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human