Objective It is widely recognized that Type 1 Diabetes (T1D) outcomes are worse among Hispanic children; however, little is published about the perspectives of these patients and their caregivers. Our intent was to characterize the lived experience of Hispanic caregivers of children with T1D, focusing on the role of language and culture and their perspectives on current medical care and alternative care models. We studied Hispanic caregivers of patients (age 2–17 years) with T1D of greater than 6 months' duration. Research Design and Methods We completed semi‐structured interviews and focus‐groups of a purposive sample of 20 members of our population of interest. We developed a codebook and completed multidisciplinary consensus coding, then conducted iterative thematic analysis using qualitative software and discussion to generate themes. Results We gathered data from 20 Hispanic caregivers of T1D patients (11.37 ± 3.00 years old, 4.80 ± 2.84 years since diagnosis). 85% of caregivers were female, 80% preferred Spanish, and 15% were college‐educated. Our analysis yielded 4 themes across the participants: (1) Culturally‐based nutrition challenges, (2) Social isolation and lack of support for T1D care, (3) Hesitancy to fully embrace diabetes technology, and (4) Deferential views of care experience and providers. Overarching all of these themes was support for Hispanic group‐based models of care tailored to address these concerns. Conclusions The unique concerns among Hispanic caregivers of children with T1D suggest the importance of culturally tailored interventions to improve care. With successful implementation, such interventions could diminish widening disparities in healthcare outcomes.

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Many children with type 1 diabetes (T1D) do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of appointments with a dietitian (RD) or how satisfied they are with their nutrition care. To better understand caregiver nutrition experiences and perceptions, we surveyed 838 families of children <18 years old receiving T1D care at Boston Children’s Hospital (BCH). Of 184 (22%) responses, 159 with complete data were analyzed. Using multivariable logistic regression, we assessed factors associated with caregiver (1) perception of the necessity for annual nutrition visits; (2) satisfaction with nutrition care and (3) encouragement from a nurse or doctor to meet with an RD. Covariates included child’s age, diabetes duration, gender, race and ethnicity, and diabetes technology use. Age and diabetes duration were categorized as <13 and ≥ 13 years old and ≤ 3 and > 3 years, respectively. Among children in the analysis, 55% were ≥ 13 years old and 51% had T1D for ≤ 3 years. Over half (56.6%) of respondents considered it necessary to see a RD every year. Older age (aOR=2.06, 95% CI [1.01, 4.20]) and shorter disease duration (aOR=2.50, 95% CI [1.22, 5.12]) were associated with this perception. Less than half (47.8%) reported satisfaction with their nutrition care, with shorter disease duration associated with a higher likelihood of satisfaction (aOR=2.24, 95% CI [1.13, 4.42]). Only 61.4% of respondents reported encouragement from a nurse or doctor to meet with a RD. No demographic or clinical characteristics were associated with this finding. Our findings suggest that caregiver satisfaction with nutrition care and its perceived need for children with T1D may wane with longer disease duration. However, the perceived need for nutrition services is also higher in parents of teens. Future work should delineate strategies for engaging families in nutrition education that is more tailored to later stages of the T1D journey. In addition, there is a need for teen-focused T1D nutrition care curricula. Disclosure E. N. Gordon: None. B. S. Dykeman: None. K. Greco: None. E. Rhodes: Other Relationship; Self; AstraZeneca. K. Garvey: None.

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