{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:37:36Z","timestamp":1792798656032,"version":"4.5.0"},"reference-count":28,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T00:00:00Z","timestamp":1694476800000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Institutes of Health\/National Institute of Diabetes and Digestive and Kidney Diseases","award":["R01-DK127493"],"award-info":[{"award-number":["R01-DK127493"]}],"id":[{"id":"https:\/\/ror.org\/00adh9b73","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2023,8,29]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Diabetes distress (DD) describes the unrelenting emotional and behavioral challenges of living with, and caring for someone living with, type 1 diabetes (T1D). We investigated associations between parent-reported and child-reported DD, T1D device use, and child glycated hemoglobin (HbA1c) in 157 families of school-age children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design and methods<\/jats:title>\n                    <jats:p>Parents completed the Parent Problem Areas in Diabetes-Child (PPAID-C) and children completed the Problem Areas in Diabetes-Child (PAID-C) to assess for DD levels. Parents also completed a demographic form where they reported current insulin pump or continuous glucose monitor (CGM) use (ie, user\/non-user). We measured child HbA1c using a valid home kit and central laboratory. We used correlations and linear regression for our analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Children were 49% boys and 77.1% non-Hispanic white (child age (mean\u00b1SD)=10.2\u00b11.5 years, T1D duration=3.8\u00b12.4 years, HbA1c=7.96\u00b11.62%). Most parents self-identified as mothers (89%) and as married (78%). Parents\u2019 mean PPAID-C score was 51.83\u00b116.79 (range: 16\u201396) and children\u2019s mean PAID-C score was 31.59\u00b112.39 (range: 11\u201366). Higher child HbA1c correlated with non-pump users (r=\u22120.16, p&lt;0.05), higher PPAID-C scores (r=0.36, p&lt;0.001) and higher PAID-C scores (r=0.24, p&lt;0.001), but there was no association between child HbA1c and CGM use. A regression model predicting child HbA1c based on demographic variables, pump use, and parent-reported and child-reported DD suggested parents\u2019 PPAID-C score was the strongest predictor of child HbA1c.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our analyses suggest parent DD is a strong predictor of child HbA1c and is another modifiable treatment target for lowering child HbA1c.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjdrc-2023-003607","type":"journal-article","created":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T20:35:34Z","timestamp":1694550934000},"page":"e003607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Parental diabetes distress is a stronger predictor of child HbA1c than diabetes device use in school-age children with type 1 diabetes"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8902-6965","authenticated-orcid":false,"given":"Susana R","family":"Patton","sequence":"first","affiliation":[{"name":"Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kahhan","sequence":"additional","affiliation":[{"name":"Pediatrics, Nemours Children's Health System, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica S","family":"Pierce","sequence":"additional","affiliation":[{"name":"Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8458-2973","authenticated-orcid":false,"given":"Matthew","family":"Benson","sequence":"additional","affiliation":[{"name":"Pediatrics, Nemours Children's Health System, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry A","family":"Fox","sequence":"additional","affiliation":[{"name":"Pediatrics, Nemours Children's Health System, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A","family":"Clements","sequence":"additional","affiliation":[{"name":"Pediatrics, Endocrinology, Children's Mercy Hospital & Clinics, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,9,12]]},"reference":[{"key":"2025073112421746000_11.5.e003607.1","doi-asserted-by":"crossref","first-page":"S230","DOI":"10.2337\/dc23-S014","article-title":"14. children and adolescents: standards of care in diabetes-2023","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"key":"2025073112421746000_11.5.e003607.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4894","article-title":"HbA(1c) level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study","volume":"366","author":"Lind","year":"2019","journal-title":"BMJ"},{"key":"2025073112421746000_11.5.e003607.3","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/pedi.12477","article-title":"Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases","volume":"18","author":"Haynes","year":"2017","journal-title":"Pediatr Diabetes"},{"key":"2025073112421746000_11.5.e003607.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-014-3272-2"},{"key":"2025073112421746000_11.5.e003607.5","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2018.0384"},{"key":"2025073112421746000_11.5.e003607.6","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1111\/pedi.12575","article-title":"Screening and support for emotional burdens of youth with type 1 diabetes: strategies for diabetes care providers","volume":"19","author":"Hilliard","year":"2018","journal-title":"Pediatr Diabetes"},{"key":"2025073112421746000_11.5.e003607.7","article-title":"Erratum. 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