Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder characterized by an absolute insulin deficiency, resulting in persistent hyperglycemia. It remains a significant global health concern, affecting millions worldwide. Upon diagnosis, patients require lifelong insulin therapy to manage glycemic levels and mitigate disease-associated complications (1). Alarmingly, the prevalence of T1DM among young children is rising, with 15-20% of new cases occurring in children under the age of five (2,3). The reasons for this trend, particularly in this age group, remain unclear.

India has been labeled the "diabetes capital of the world," housing the second-largest population of children and adolescents aged 0-19 years with T1DM (128,000), following the United States (4). The annual incidence of T1DM in India is estimated at 10.5 per 100,000, with the peak onset occurring between 10-12 years of age. Regional data from Karnataka reports an incidence of 3.7 per 100,000 among boys and 4.0 per 100,000 among girls (5). Managing T1DM in young children presents unique challenges due to factors such as heightened insulin sensitivity, a shortened "honeymoon period," and developmental considerations, including cognitive and behavioral immaturity.

The pathophysiology of T1DM involves autoimmune-mediated destruction of pancreatic β-cells, often beginning years before clinical diagnosis. The presence of multiple islet cell autoantibodies, particularly in children with the high-risk HLA DR3/DR4-DQ8 genotype, significantly increases the likelihood of disease progression (6). Environmental factors, including viral infections, dietary antigens, and maternal influences during pregnancy, are believed to interact with genetic predispositions to initiate β-cell autoimmunity (7,8). Furthermore, a global rise in T1DM incidence over the last few decades underscores the potential role of modern environmental changes in its pathogenesis (9).

Clinically, T1DM presents with a range of symptoms, including polyuria, polydipsia, weight loss, and fatigue. In some cases, the initial presentation may involve diabetic ketoacidosis (DKA), a life-threatening condition requiring urgent medical attention (10). Accurate diagnosis relies on criteria such as elevated fasting glucose levels, oral glucose tolerance test (OGTT) results, and glycated hemoglobin (HbA1c) levels (11). Effective management of T1DM encompasses insulin therapy, dietary regulation, physical activity, and blood glucose monitoring. The cornerstone of treatment is patient and family education, emphasizing the need for multidisciplinary care to achieve optimal glycemic control and improve quality of life (12).

This study aims to evaluate the quality of life in children with T1DM and identify the factors influencing their well-being. By addressing these aspects, it seeks to contribute to improved clinical care and support systems for affected children and their families.

This hospital-based cross-sectional observational study aimed to evaluate the quality of life (QoL) in children with Type 1 Diabetes Mellitus (T1DM) attending the diabetic outpatient department (OPD) at Indira Gandhi Institute of Child Health (IGICH). The study was conducted over a period of 18 months, from January 2020 to June 2021, and included children aged 8 to 18 years diagnosed with T1DM who had been on follow-up for at least one year.

The inclusion criteria encompassed children aged 8-18 years with T1DM and a minimum one-year follow-up in the diabetic OPD. Exclusion criteria included children with systemic illnesses such as cardiac, respiratory, chronic kidney, or chronic liver diseases, as well as those with major psychiatric illnesses in either the child or parent. Eligible participants and their parents were informed about the study in detail, and written consent or assent (for children aged 12 years or older) was obtained prior to enrollment.

The quality of life was assessed using the Quality of Life Instrument in Indian Diabetes (QOLID), a validated tool designed for diabetes-specific QoL assessment in Indian patients. QOLID evaluates eight domains: general health, treatment satisfaction, symptom bother, financial worries, emotional health, diet satisfaction, role limitation due to physical health, and physical endurance. It consists of 34 questions scored on a Likert scale from 1 to 5, where lower scores indicate poorer QoL and higher scores represent better QoL. Domain scores were calculated by summing item scores, standardizing them by dividing by the maximum possible score for that domain, and multiplying by 100. An overall QoL score was obtained by averaging the standardized scores across the eight domains. A score of >140 (80%) was identified as the cutoff for better QoL based on sensitivity (78%) and specificity (65%) from previous studies. Participants with scores <140 were considered to have impaired QoL.

The QOLID instrument was initially designed in English and subsequently translated into Kannada, Hindi, Tamil, and Telugu using forward and backward translation. Modifications were made to ensure relevance for the pediatric population, such as replacing "you" with "your child" and "work" with "school/school activities." The tool was validated by pediatric endocrinologists with minor adjustments for clarity.

The sample size was calculated to estimate the proportion of children with impaired QoL, assuming an anticipated prevalence of 10%, a 6% margin of error, and a 90% confidence interval. Statistical analysis was performed using SPSS version 20.0, with a p-value of <0.05 considered statistically significant.

A total of 96 children with Type 1 Diabetes Mellitus (T1DM) were included in the study. The results are summarized as follows:

Table 1: Demographics and Socioeconomic Characteristics

The study group consisted predominantly of females (59.4%) with a female-to-male ratio of 1.4:1. The mean age of participants was 12.53 years, with most children speaking Kannada (74.0%). Regarding socioeconomic status, 39.5% were from middle-class families, followed by 35.4% from lower-class families (Table 1).

Table 2: Clinical Characteristics

The age at diagnosis ranged from 1 to 14 years, with a mean of 5.43 years. Among the study population, 60.4% had an HbA1c value below 8, while 39.6% had an HbA1c value above 8 (Table 2).

Table 3: Quality of Life (QoL) and Correlation with Parameters

In the study, 62.5% of children had a QoL score above 8, indicating a better quality of life, while 37.5% had scores below 8, reflecting impaired QoL. Socioeconomic status (p=0.02) and HbA1c values (p<0.001) showed statistically significant correlations with QoL scores. Other variables, such as age at diagnosis (p=0.212), gender (p=0.868), and father’s occupation (p=0.652), were not statistically significant (Table 3).

The findings revealed that the mean total QoL score was 8.1 ± 0.97, with the general health domain being most affected (mean score: 7.11), while physical endurance was least affected (mean score: 8.8). HbA1c levels were significantly negatively correlated with QoL scores (r=-0.808, p<0.001), indicating that higher HbA1c levels were associated with poorer QoL.

This study assessed the quality of life (QoL) in 96 children with Type 1 Diabetes Mellitus (T1DM) attending a diabetic outpatient department (OPD). The findings revealed that 37.5% of the participants had impaired QoL, with the most affected domains being general health (71%), treatment satisfaction (79%), and emotional health (80%). The mean total QOLID score was 81%, indicating that while the majority had acceptable QoL, a significant proportion experienced challenges in disease management and overall well-being.

In comparison with similar studies, the prevalence of impaired QoL in this study aligns with the findings of Puri et al., who reported impaired QoL in 30% of children with T1DM (1). However, Kumar et al. observed a lower prevalence of 18%, likely due to their study population comprising older children with better disease comprehension and coping mechanisms (2). Internationally, Ausili et al. noted that QoL was significantly affected by metabolic control and early-onset diabetes in their Italian cohort (3). Although early onset of diabetes did not influence QoL in our study, lower HbA1c levels were significantly associated with better QoL, consistent with findings from studies conducted in Kuwait (4) and Greece (5).

In our study, 60% of children had an HbA1c value below 8, and HbA1c was identified as the most critical determinant of QoL (p < 0.001). These findings corroborate those of Hoey et al., who demonstrated that better glycemic control was associated with greater satisfaction, fewer worries, and improved health perception (6). Similarly, Rakesh Kumar et al. emphasized the significance of HbA1c as a determinant of QoL in Indian children with T1DM (7). The strong correlation between glycemic control and QoL underscores the need for meticulous metabolic management in pediatric diabetes care.

Socioeconomic status also emerged as a significant factor influencing QoL (p = 0.02), with children from lower socioeconomic backgrounds experiencing greater challenges. This aligns with studies by Grey et al. and Puri et al., both of which highlighted the adverse impact of low socioeconomic status on QoL (8,9). In contrast, Wagner et al. found no significant differences in QoL between diabetic and non-diabetic children in their observational study, likely due to better resources, education, and social support in their study population (10).

Gender and age at diagnosis did not significantly impact QoL in this study, in contrast to findings by Kalvya et al., who reported better QoL among older children and male participants (5). Additionally, while Ausili et al. found early-onset diabetes to negatively affect QoL, our study did not identify any significant association with age at diagnosis. This disparity could be attributed to cultural and healthcare differences, as well as better parental awareness and engagement in our study cohort (11-15).

The validated QOLID questionnaire used in this study was specifically designed for Indian populations, ensuring relevance to the cultural and linguistic context. Its use provided a comprehensive assessment of diabetes-specific and health-related QoL domains. However, certain limitations need to be acknowledged. The absence of a control group restricts comparative analysis with non-diabetic children, and the QOLID questionnaire may not cover all aspects of QoL comprehensively. Future studies should consider longitudinal designs and incorporate more diverse assessment tools to address these limitations.

In conclusion, this study highlights that 37.5% of children with T1DM experience impaired QoL, with significant influences from socioeconomic status and glycemic control. Periodic QoL assessments and targeted interventions are essential to address these challenges and improve disease outcomes. These findings contribute valuable insights to the limited literature on pediatric diabetes care in resource-constrained settings, emphasizing the need for holistic management approaches.

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