Health-Related Quality-of-Life and Associated Factors Among Children and Adolescents with Type 1 Diabetes Mellitus: A Cross-Sectional Study

Abstract

Background

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases during childhood and adolescence. It threatens the health and endangers life with consequences for the physical and emotional development of the child and adolescent. Our study aimed at determining the health-related quality-of-life (HRQoL) and factors affecting it in children and adolescents with T1DM.

Methods

A hospital-based cross-sectional study was conducted among 379 randomly selected children and adolescents, 5–18 years of age, with T1DM on follow-up at endocrine clinics from 25 August to 25 September 2021. PedsQLTM 4.0 generic core scales were used to collect the data. Paired sample t-test was used to compare children’s and adolescents’ self-reports and caregiver’s reports. Bivariable and multivariable linear regression is used to explore to identify significant predictor factors of HRQoL.

Results

Total mean score of HRQoL was 88.42±10.82 as reported by the children and adolescents and 82.17±12.65 reported by their primary caregivers. According to self-reports, age (β=−0.197, p=0.028), mothers’ educational status (β=0.242, p<0.001), fathers’ educational status (β=0.259, p<0.001), fathers’ occupation (β=0.170, p=0.038), frequency of insulin administration (β=−0.132, p=0.007), diabetes duration (β=−0.101, p=0.050), and frequency of monitoring of blood glucose (β=0.165, p=0.006) were statistically significant predictors of HRQoL, explaining 21.6% of the variability of total HRQoL scores of children and adolescents (R²=0.216, F(21,357)=5.968, p<0.001).

Conclusion

Children and adolescents with T1DM in Ethiopia have relatively good HRQoL. Increased age, longer diabetes duration, and insulin administrations of three times per day were associated with decreased HRQoL scores. Educated parents, having an employed father, and frequent blood glucose monitoring were associated with higher HRQoL scores.

Keywords:

• adolescents
• quality-of-life
• children
• type-I diabetic mellitus
• PedsQL
• Addis Ababa
• Ethiopia

Abbreviations

FBS, fasting blood sugar; HgA1c, hemoglobin A1C; HRQoL, health-related quality-of-life; PedsQL^TM, pediatric quality-of-life inventory; SPHMMC, St. Paul’s Hospital Millennium Medical College; T1DM, type 1 diabetes mellitus; TASH, Tikur Anbessa Specialized Hospital; WHO, World Health Organization; Y12MC, Yekatit 12 Medical College; ZMH, Zewditu Memorial Hospital.

Data Sharing Statement

All data generated or analyzed during this study are available from the corresponding author on reasonable request.

Ethical Considerations and Informed Consent

Ethical clearance and approval were obtained from the Institutional Research Review Boards of St. Paul’s Hospital Millennium Medical College (PM23/294), Tikur Anbessa Specialized Hospital (ህጻ/ህት/262/13), Yekatit 12 Hospital Medical College (14/12), and from Addis Ababa public health research and emergency management directorate (A/A/5962/227). Permission to carry out the study was given by TASH, SPHMMC, Y12MC, and ZMH Hospital administrations. After a detailed explanation of the study purpose, written informed consent was obtained from caregivers and assent from participating children and adolescents. Confidentiality and privacy of the participant have been maintained throughout the process of data collection. The data were kept confidential and used for the intended purpose only. Participation in the study was on a voluntary basis. This study was conducted with a serious consideration of the coronavirus pandemic. So that, in order to minimize the risk of infection transition during the face-to-face interview, the interview was conducted in a ventilated area with keeping enough distance between the interviewer and interviewees, and also facemasks were worn by all participants as well the data collectors. This study was conducted as per the Declaration of Helsinki.

Acknowledgments

The authors would like to acknowledge the study participants, data collectors, and administrative bodies of SPHMMC, TASH, TBH, Y12HMC, and ZMH for their permission.

Author Contributions

All authors made a significant contribution to the study in the conception, study design, execution, acquisition of data, analysis, and interpretation; were involved in drafting, substantially revising, and critically reviewing the article; and have agreed on the journal to which the article will be submitted. All authors reviewed and agreed on the revised versions of the article before submission and agreed to take responsibility and be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.