Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus.
OBJECTIVE
In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified.


METHODS
A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire), family functionality (family APGAR), support of another person in patient care, stress (Perceived Stress Scale), and socioeconomic status (Bronfman questionnaire). Multivariate logistic and linear regression analyses were performed.


RESULTS
The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p=0.001). While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p=0.011) and stress (β 1.918, 95% CI 1.10-2.736, p=0.001) in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p=0.008) were associated with higher levels of glycated hemoglobin.


CONCLUSIONS
Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Epidemiología Clínica, Mexico City, Mexico. Electronic address: zuritajn@hotmail.com.
Jessie Nallely
JN
Zurita-Cruz
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Endocrinología Pediátrica, Mexico City, Mexico.
Elisa
E
Nishimura-Meguro
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Epidemiología Clínica, Mexico City, Mexico.
Miguel Angel
MA
Villasís-Keever
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Endocrinología Pediátrica, Mexico City, Mexico.
Maria Elena
ME
Hernández-Méndez
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Endocrinología Pediátrica, Mexico City, Mexico.
Eulalia
E
Garrido-Magaña
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Unidad de Endocrinología Pediátrica, Mexico City, Mexico.
Aleida De Jesús
AJ
Rivera-Hernández
D001786:Blood Glucose / Q000032:analysis*; D017028:Caregivers / Q000193:education*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D008297:Male; D008800:Mexico; D012307:Risk Factors
D001786:Blood Glucose
Caregiver; Cuidador; Diabetes tipo 1; Pediatria; Pediatrics; Type 1 diabetes