Finnish diabetes-related quality of life questionnaire for children and adolescents: Reliability and validity.

AIM: To study the psychometric properties, reliability and validity of the FinDiab quality-of-life questionnaire (FDQL), a strength-oriented quality-of-life (QOL) questionnaire for children and adolescents with type 1 diabetes (T1D). METHODS: Participants were 215 youths with T1D (aged 10-17 years). They completed FDQL and comparison questionnaires (KINDL-R and SDQ). Demographic and disease measures were collected from the participants' medical records. The questionnaire's psychometric properties were investigated. Construct validity was studied through principal component analysis using Promax rotation, reliability with alphas, and criterion and convergent validity with correlations between sum scale, subscales, demographic and disease factors, and comparison measures. RESULTS: FDQL demonstrated an adequate range of measurement and feasibility. The four-factor solution was found to be optimal, resulting in the subscales of flexibility with diabetes, well-being, social relations and health behaviour. The sum scale correlated significantly with glycaemic control and the psychosocial and QOL comparison measures. Construct, criterion and convergent validity of the subscales was also good. Children under 14 years of age reported better QOL than older adolescents. CONCLUSION: FDQL is a practical QOL assessment method focusing on strengths. The questionnaire has good validity and reliability and is easy to use as a clinical tool.

The effect of hypoglycaemia on neurocognitive outcome in children and adolescents with transient or persistent congenital hyperinsulinism.

AIM: To examine the hypoglycaemic effect on neurodevelopmental outcome in patients with transient and persistent congenital hyperinsulinism (CHI) born in the 21st century. METHOD: A cohort of 117 patients (66 males, 51 females) with CHI aged 5 to 16 years (mean age 8y 11mo, SD 2y 7mo) were selected from a Finnish nationwide registry to examine all the patients with similar methods. Neurodevelopment was first evaluated retrospectively. The 83 patients with no risk factors for neurological impairment other than hypoglycaemia were recruited and 44 participated (24 males, 20 females; mean age 9y 7mo, SD 3y 1mo) in neuropsychological assessment with the Wechsler Intelligence Scale for Children, Fourth Edition and the Finnish version of the Developmental Neuropsychological Assessment, Second Edition domains of attention, language, memory, sensorimotor, and visual functioning. RESULTS: In retrospective analysis, transient and persistent CHI groups had similar prevalences of mild (22% and 18% respectively) or severe (5% and 7% respectively) neurodevelopmental difficulties. In clinical assessment, the neurocognitive profile was within the average range in both groups, but children with persistent CHI showed significant but restricted deficits in attention, memory, visual, and sensorimotor functions compared with the general population. The transient CHI group did not differ from the standardization samples. INTERPRETATION: Besides the more apparent broader neurological deficits, children with persistent CHI have an increased risk for milder specific neurocognitive problems, which should be considered in the follow-up. WHAT THIS PAPER ADDS: Children with persistent congenital hyperinsulinism showed deficits in attention, memory, visual, and sensorimotor functions. The deficits were potentially of hypoglycaemic origin. Children with transient hyperinsulinism did not differ from the general population.

EL EFECTO DE LA HIPOGLUCEMIA SOBRE EL RESULTADO NEUROCOGNITIVO EN NIÑOS Y ADOLESCENTES CON HIPERINSULINISMO CONGÉNITO TRANSITORIO O PERSISTENTE: OBJETIVO: Examinar el efecto hipoglucémico sobre el resultado del neurodesarrollo en pacientes nacidos en el siglo XXI con hiperinsulinismo congénito (HIC) transitorio y persistente. MÉTODO: Una cohorte de 117 pacientes (66 varones, 51 mujeres) con HIC de 5 a 16 años de edad (media de 8 años 11 meses, DS 2 años 7 meses) fueron seleccionados de un registro nacional finlandés para examinar a todos los pacientes con métodos similares. El neurodesarrollo se evaluó por primera vez de forma retrospectiva. Los 83 pacientes sin factores de riesgo para el deterioro neurológico distintos de la hipoglucemia fueron reclutados y 44 de ellos participaron (24 varones, 20 mujeres; edad media 9 años 7 meses, DS 3 años 1mes) en la evaluación neuropsicológica con la Escala de Inteligencia de Wechsler y la versión finlandesa de la Evaluación Neuropsicológica del desarrollo, segunda edición, incluyendo los dominios de atención, lenguaje, memoria, sensoriomotor y funcionamiento visual. RESULTADOS: En el análisis retrospectivo, los grupos de HIC transitorios y persistentes tuvieron prevalencias similares de dificultades del neurodesarrollo leves (22% y 18% respectivamente) o graves (5% y 7% respectivamente). En la evaluación clínica, el perfil neurocognitivo estuvo dentro del rango promedio en ambos grupos, pero los niños con HIC persistente mostraron déficits significativos pero restringidos en la atención, memoria, funciones visuales y sensomotrices en comparación con la población general. El grupo de HIC transitorio no difirió de las muestras de estandarización. INTERPRETACIÓN: Además de los déficits neurológicos más aparentes generalizados, los niños con HIC persistente tienen un mayor riesgo de presentar problemas neurocognitivos específicos más leves, que deben ser considerados en el seguimiento.

O EFEITO DA HIPOGLICEMIA NO RESULTADO NEUROCOGNITIVO EM CRIANÇAS E ADOLESCENTES COM HIPERINSULINEMIA CONGÊNITA TRANSITÓRIA OU PERSISTENTE: OBJETIVO: Examinar o efeito hipoglicêmico no resultado neurodesenvolvimental em pacientes com hyperinsulinemia congênita (HIC) transitória ou persistente nascidas no século 21. MÉTODO: Uma coorte de 117 pacientes (66 do sexo masculino, 51 do sexo feminino) com HIC e idades de 5 a 16 anos (média de idade 8a 11m, DP 2a 7m) foram selecionados de um registro nacional finlandês para exame com métodos similares. Primeiramente, o neurodesenvolvimento foi avaliado retrospectivamente. Os 83 pacientes sem risco para deficiência neurológica além da hipoglicemia foram recrutados, e 44 participaram (24 do sexo masculino, 20 do sexo feminino; média de idade 9a 7m, DP 3a 1m) na avaliação neuropsicológica com a escala Wechsler de Inteligência, e a versão finlandesa da Avaliação Neuropsicológica Desenvolvimental, segunda edição, nos domínios de atenção, linguagem, memória, sensório-motor, e funcionamento visual. RESULTADOS: Na análise retrospective, os grupos com HIC transitória e persistente tiveram prevalências similares de dificuldades neurodesenvolvimentais leves (22% e 18% respectivamente) ou severa (5% e 7% respectivamente). Na avaliação clínica, o perfil neurocognitivo estava dentro da média para ambos os grupos, mas crianças com HIC persistente mostraram deficits significantes, mas restritos, nas funções de atenção, de memória, visuais e sensório-motoras comparado com a população em geral. O grupo com HIC transitória não diferiu das amostras padronizadas. INTERPRETAÇÃO: Além dos deficits neurológicos mais amplos e aparentes, crianças com HIC persistente têm risco aumentado de problemas neurocognitivos específicos leves, o que deve ser considerado no acompanhamento.

Psychological distress of children with early-onset type 1 diabetes and their mothers' well-being.

AIM: Few studies have focused on the psychological adjustment of pre-adolescent children with type 1 diabetes. This study examined psychosocial functioning in nine- and 10-year-old children with early-onset type 1 diabetes, and their mothers, and associations between psychosocial functioning and diabetes management. METHODS: The mothers of 63 children with early-onset diabetes and 86 healthy children evaluated their own psychosocial functioning, and their child's, with standardised rating scales. We used general linear models to analyse the children's behaviour problems and the mothers' well-being. Associations between the children's behaviour problems, diabetes-related measures and the mothers' well-being were studied with partial correlations. RESULTS: Children with diabetes had more internalising problems than the controls (p = 0.001), and these were associated with poor glycaemic control at the early stage of the illness (p = 0.033) and the use of insulin pumps in girls (p = 0.004). Mothers in the diabetes group had more child-related stress than the controls (p < 0.001), and poorer well-being was associated with the children's behavioural problems (p < 0.024). CONCLUSION: Children with early-onset diabetes faced an increased risk of internalising problems in middle childhood. The mothers' psychological distress was associated with children's behaviour problems rather than their diabetes.

Academic skills in children with early-onset type 1 diabetes: the effects of diabetes-related risk factors.

AIM: The study aimed to assess the effects of diabetes-related risk factors, especially severe hypoglycaemia,on the academic skills of children with early-onset type 1 diabetes mellitus (T1DM). METHOD: The study comprised 63 children with T1DM (31 females, 32 males; mean age 9 y 11 mo,SD 4 mo) and 92 comparison children without diabetes (40 females, 52 males;mean age 9 y 9 mo,SD 3 mo). Children were included if T1DM had been diagnosed before the age of 5 years and if they were aged between 9 and 10 years at the time of study. Children were not included if their native language was not Finnish and if they had a diagnosed neurological disorder that affected their cognitive development. Among the T1DM group, 37 had and 26 had not experienced severe hypoglycaemia and 26 had avoided severe hypoglycaemia. Severe hypoglycaemia, diabetic ketoacidosis(DKA), and glycaemic control were used as T1DM-related factors. Task performance in reading, spelling, and mathematics was compared among the three groups, and the effects of the T1DM-related factors were analysed with general linear models. RESULTS: The groups with (p<0.001) and without (p=0.001) severe hypoglycaemia demonstrated a poorer performance than the comparison group in spelling, and the group without severe hypoglycaemia showed a poorer performance than the comparison group in mathematics (p=0.003).Severe hypoglycaemia, DKA, and recent glycaemic control were not associated with poorer skills,but poorer first-year glycaemic control was associated with poorer spelling (p=0.013). INTERPRETATION: An early onset of T1DM can increase the risk of learning problems, independently of the history of severe hypoglycaemia or DKA. Poorer glycaemic control after the first year of T1DM is associated with a poorer acquisition of academic skills indicating the effect of the timing of metabolic aberrations on cognitive development.

[Is it necessary to monitor the cognitive development of a child having diabetes?]. / Onko tarpeen seurata diabetesta sairastavan lapsen kognitiivista kehitystä?

Metabolic disorders associated with type 1 diabetes may affect brain function both momentarily during excessively low or high blood glucose levels and by causing permanent alterations. These may have an influence on the cognitive development of a child who has been diagnosed with diabetes at a very young age. Significant learning problems are rare, but their early detection and appropriate support are part of good clinical practice. Good glucose control protects also the brain.

Verbal and academic skills in children with early-onset type 1 diabetes.

AIM: Basic verbal and academic skills can be adversely affected by early-onset diabetes, although these skills have been studied less than other cognitive functions. This study aimed to explore the mechanism of learning deficits in children with diabetes by assessing basic verbal and academic skills in children with early-onset diabetes and in comparison children. In addition, the incidence of dyslexia (< or =10th centile in reading speed or reading-spelling accuracy) was studied. METHOD: The performance of 51 children with early-onset diabetes (25 females, 26 males; mean age 9y 11mo, SD 4mo; range 9-10y) was compared with that of 92 children without diabetes (40 females, 52 males; mean age 9y 10mo, SD 3mo; range 9-10y) in the tasks of phonological processing, short-term memory, rapid automatized naming, reading, spelling, and mathematics. RESULTS: The performance of children with diabetes was poorer than that of the comparison children in phonological processing (p=0.001), spelling accuracy (p<0.001), and mathematics (p=0.024). They learned to read later (p=0.013), but reading performance and the incidence of dyslexia in the third grade (aged 9-10y) were similar in the two groups. INTERPRETATION: Children with early-onset diabetes are prone to minor learning difficulties in their early school years as a result of deficits in phonological processing.

Maternal Parenting Styles and Glycemic Control in Children with Type 1 Diabetes.

The purpose of this study is to examine differences in parenting styles between mothers of children with type 1 diabetes and mothers of healthy children and to explore relationships between parenting styles and glycemic control of children with diabetes. Mothers of 63 children with diabetes and mothers of 83 children without diabetes reported their parenting styles using the Blocks' Child Rearing Practices Report, when their child was 9⁻10 years old. Glycemic control of the children with diabetes was evaluated 1 year after diagnosis (<6 years of age) and at the time of the study (at 9⁻10 years). Mothers of children with diabetes used more psychological control than mothers of healthy children. Among girls with diabetes, poorer early glycemic control was associated with mothers' subsequent greater use of psychological control. Behavioral control was positively associated with poorer current glycemic control. In boys, psychological control was positively associated with poorer current glycemic control. Psychological control in families with diabetes needs attention, because it has shown to be associated with poorer diabetes care.

Neurocognitive functioning in children with type-1 diabetes with and without episodes of severe hypoglycaemia.

Previous studies have shown that recurrent severe hypoglycaemia can cause long-term cognitive impairment in children with type-1 diabetes, but the results are controversial, possibly due to the heterogeneity of samples and lack of comprehensive neuropsychological assessments of children. The aim of this study was to assess the effects of diabetes and severe hypoglycaemia on the neurocognitive functioning of children with a standardized, wide age-range neuropsychological test battery designed for the assessment of children. Eleven children with diabetes and a history of severe hypoglycaemia, 10 children with diabetes without a history of severe hypoglycaemia, and 10 healthy control children (a total of 31 children: 14 males and 17 females, age range 5 years 6 months to 11 years 11 months, mean 9 years 4 months, SD 1 year 11 months) were studied using the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the NEPSY, a Developmental Neuropsychological Assessment. The NEPSY assessed development in attention and executive functions, language, sensorimotor functions, visuospatial processing, and learning and memory. Children with a history of severe hypoglycaemia had more neuropsychological impairments, more learning difficulties (as reported by parents), and needed more part-time special education than those in the other groups. Significant differences were found in verbal short-term memory and phonological processing. Results suggest that severe hypoglycaemia is a risk factor for learning due to deficits in auditory-verbal functioning.