{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T16:22:02Z","timestamp":1788193322411,"version":"build-2803163510"},"reference-count":35,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,7]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Type 1 diabetes mellitus (T1DM) is a chronic disease that requires lifestyle amendment, demanding treatment and regular glycaemic control, all of which can significantly impact the health-related quality of life (HRQoL) of affected children. This study aimed to assess the HRQoL of T1DM in a Tunisian paediatric population and to identify the influencing factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted at a tertiary care paediatric hospital in Tunis, Tunisia, over a 6-month period from November 2022 to April 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 120 children with T1DM, aged 3\u201317 years, and their parents were enrolled. Inclusion criteria included children with a confirmed diagnosis of T1DM and regular follow-up at the study centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>HRQoL of children with T1DM was assessed using the validated Tunisian version of the KINDL-R questionnaire. The KINDL-R scores range from 0 to 100, with higher scores indicating better perceived HRQoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 120 children with T1DM. HRQoL was considered satisfactory in 94 children (78.3%), with a mean total score of 69\u00b120.8 (range: 21.4\u201399.3). Parents reported significantly lower HRQoL scores compared with their children\u2019s self-assessments, with a mean total score of 59.2\u00b120.4 (range: 14.3\u201397.5). Multivariate linear regression analysis identified several factors independently associated with impaired HRQoL, including a glycated haemoglobin level &gt;9%, a child\u2019s age greater than 14 years, a history of ketoacidosis decompensation, a daily insulin dose \u22650.78\u2009IU\/kg\/day, more than 10 hypoglycaemic episodes per month and parental divorce. Conversely, the use of insulin analogues and good academic performance were independently associated with a more satisfactory HRQoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>T1DM is not exclusively a clinical and biological condition, but it also affects the psychological well-being of the child and the entire family dynamic. Despite its recognised importance, psychosocial support is still insufficient. Therapeutic education programmes seem to be a relevant initiative for improving the HRQoL of children with T1DM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-100825","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T10:05:34Z","timestamp":1752833134000},"page":"e100825","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Health-related quality of life and its influencing factors in children with type 1 diabetes in Tunisia: a cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5200-1844","authenticated-orcid":false,"given":"Sofien","family":"Atitallah","sequence":"first","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Hassine","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salem","family":"Yahyaoui","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania","family":"Ben Rabeh","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Missaoui","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olfa","family":"Bouyahia","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Mazigh","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Boukthir","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia"},{"name":"Pediatric Department C, Children\u2019s Hospital Bechir Hamza, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"2025121411545676000_15.7.e100825.1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-022-01762-w"},{"key":"2025121411545676000_15.7.e100825.2","unstructured":"Tunisia diabetes report 2000 \u2014 2045. 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