Family and household structure are associated with acute type 1 diabetes complications: results of cross‐sectional analyses

Abstract

Aim To examine the association of family/household structure with short-term diabetes complications in adolescents and emerging adults with early-onset type 1 diabetes in more detail. Methods Data on 1690 11-21-year-olds with type 1 diabetes were used to estimate associations of family/household structure with self-reported severe hypoglycaemia, hospitalizations for severe hypoglycaemia or diabetic ketoacidosis, applying multiple negative binomial regression. Results Compared with living with both biological parents living with a single mother was associated with an increased rate of hospitalizations for ketoacidosis (incidence rate ratio 1.71, 95% CI 1.00-2.82). Incidence rate ratio of hospitalizations for ketoacidosis was similar (1.67, 95% CI 0.91-3.07) if the mother lived with a partner, however, hypoglycaemia-related hospitalizations increased (3.66, 95% CI 1.54-8.71). Participants living with a single father had 4.43 (95% CI 1.30-15.05) /10.42 (95% CI 1.55-70.22) times higher rates of severe hypoglycaemia and related hospitalizations, while living with a father and his partner was associated with an increased incidence rate ratio of hospitalizations for ketoacidosis (3.48, 95% CI 0.96-12.63) compared with living with both biological parents. Conclusions Findings of our exploratory analyses point to different self-reported diabetes outcomes depending on the family/household structure. If confirmed in future studies, they may help to identify young people with diabetes at risk of short-term diabetes complications.

Association of family structure with type 1 diabetes management and outcomes in adolescents: A population‐based cross‐sectional survey

“…Impaired awareness of hypoglycemia is considered a major risk factor for severe hypoglycemia in diabetes patients 31 . In our cohort, we previously found higher odds of severe hypoglycemia and related hospitalizations in adolescents living with a single father than in those living with both parents (incidence rate ratios (IRRs) 4.43 (1.30; 15.05) and 10.42 (1.55; 70.22)), 16 but associations between family structure and hypoglycemia awareness have not been reported thus far. In this study, we observed higher odds for low hypoglycemia awareness in children living with a parent and a partner than in those living with both parents.…”

“…For pairwise comparisons between the three family structure categories the Tukey–Kramer post‐hoc test for unequal sample sizes was used to adjust for multiple testing. As possible confounders, relevant variables identified in previous studies for the association between family structure and diabetes management/outcomes were selected and supplemented by possible influencing factors based on expert opinion 16‐20 . Model 1 contained, in addition to family structure, a study sample indicator to avoiding biases related to differences between surveys.…”