Family background can matter for the health of diabetic children, according to researchers in Denmark who found young patients’ blood sugar control was linked with the level of education their mothers had attained.
“One of the first explanations that comes to mind is that unequal access to healthcare may be a factor linking family background and blood sugar levels,” said study leader Nick Nielsen from department of economics at University of Copenhagen.
But studying people in Denmark, which has universal tax-financed access to healthcare, helped cancel out that factor, he told Reuters Health.
Nielsen and his team analyzed data on 4,079 children who were diagnosed with type 1 diabetes between 2000 and 2013. In type 1 diabetes, the rarer form of the disease, the body’s immune system mistakenly kills the beta cells in the pancreas that make and release the hormone insulin. Type 1 diabetes requires treatment with insulin injections.
The children were divided into 4 groups, depending on their mother’s highest level of education. Altogether, 1,643 had mothers who hadn’t gone to college, 1,548 had mothers who completed vocational or 2-year college, 695 had mothers with bachelor’s degree and 193 had mothers with master’s degree.
The researchers found that levels of so-called glycated hemoglobin, or HbA1c, HbA1c, which reflects blood sugar control over the previous three months, went down as mothers’ education level went up.
The normal range for HbA1c is 4.3% to 5.8% - but that range is difficult to achieve in diabetics. The American Diabetes Association recommends that children with type 1 diabetes strive to stay below 7.5%.
In the current study, HbA1c levels averaged 7.6% in children of mothers with advanced degrees, 7.9% in children of women with bachelor’s degrees, 8.2% in children whose mothers graduated from vocational or 2-year colleges, and 8.4% in children of mothers with no more than a high school degree.
Children of better-educated mothers also had lower rates of a dangerous condition known as diabetic ketoacidosis, and lower rates of dangerously low blood sugar that can result from overdoses of insulin.
Differences in how often kids’ blood sugar levels were checked uring the day likely explained a large part of the disparities, the authors say.
Children of the most highly educated mothers had the highest number of daily blood glucose tests, while those with a high school education or less had the lowest.
Other potential explanations, the authors write, are that mothers with higher education may be more capable of helping manage diabetes and could help their kids on how to control their disease.
Links between patient education or socioeconomic status and compliance with treatment has been shown in older studies, too.
The study is limited because it was not possible to get information on all mothers and their children in the registries.
Still, the researchers write in Diabetes Care, “For clinicians and policymakers, our results suggest that it may be beneficial to provide extra support to the least privileged children during the first few years of diabetes.”
It would also be helpful if healthcare professionals help form patient groups, Nielsen says.
“In these groups, families could help support each other outside the clinic. We think that this increased decentral support could be valuable due to the importance of peer support and “everyday” advice and knowledge sharing,” Nielsen added.
SOURCE: bit.ly/2Jaa5XW Diabetes Care, online May 23, 2019.
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