There is an increasing prevalence of diabetes among children. Caregivers’ skill is necessary for effective management of the disease. The purpose of this study is to understand caregivers’ knowledge, perception and challenges in caring for children as they impact work and children’s school absenteeism. A modified version of the Diabetes Self-Management Questionnaire (DSMQ) was administered to caregivers of diabetic children who consented during “Diabetes Parents Night” (DPN) organized by the Cumberland County School (CCS) Health Advisory Council (SHAC).
Twenty of 25 questionnaires were usable. Diabetes knowledge regarding symptoms identification in this group was relatively low. Adequate care for their diabetic children was moderate. Thirty five percent reported either forgetting or skipping administering drugs most or all of the time. Forty five percent reported occasionally feeding their children lots of sweets or other foods rich in carbohydrates all or some of the time. Forty percent indicated their children do not exercise enough. Forty seven percent of children miss school one or more times a month. Thirty five percent reported missing work one or more times a month. This pilot study indicates that caregivers need improved knowledge and care skills to manage children’s diabetes to reduce both school and work absenteeism.
Diabetes; Caregivers; Perceptions Absenteeism
Diabetes continues to grow as a source of economic and social burden on societies despite improvement in treatment and management of the disease. Globally, about 422 million people suffer from diabetes and 1.6 million die from it every year [1]. With nearly 34.2 million people in the U.S. diagnosed with diabetes, the incidence rate is estimated 6.9 per 1,000 population [2]. About 210,000 children and adolescents younger than 20 years of age are diabetic. The growing numbers of both type 1 and type 2 diabetes among young people [2] should be of public health interest as the burden of care is on parents and adult caregivers who may have their share of other life challenges. Of equal concern is the increasing prevalence of prediabetes among U.S. adolescents. One study found that 18% of US adolescents (1 in 5) had prediabetes during 2005–2016 [3]. This trend will further exacerbate the burden on caregivers in the foreseeable future. In 2017, Diabetes mellitus was the 7th leading cause of death among 15-24-year-olds in the United States [4].
In 2016, 10.1% of North Carolinians adults had Diabetes. North Carolina recorded 23.9 deaths per 100,000 people in 2018, making diabetes the seventh leading cause of death in the state. In 2017, 12.3% of NC Cumberland County adult residents had diabetes [5]. The prevalence of both type 1 and type 2 diabetes among children and adolescents is increasing at a fast pace and the causes are yet to be fully understood [6]. Diabetes prevalence among privately insured youths in NC is 11.3 -12.5 per 10,000 person-year [7] and there are no indications of it abating soon.
Studies have shown that students with diabetes missed more school days than their non-diabetic counterparts [8], [9], [10]. Although there are inconsistencies in reports about academic achievements [11], there is evidence that children with poor diabetes management do worse academically [12]. The combination of school absenteeism and poor diabetes management further jeopardize students’ academic success.
Since children's diabetes management and school attendance rest on parents or the attending adult caregivers, they must possess basic knowledge of diabetes which undergirds the self-care activities related to their children's diabetes. By the same token, it is conceivable that their children’s school absences will be disruptive to their (caregivers) normal daily routine and responsibilities like job. Caregivers of diabetic children are faced with numerous tasks which include but are not limited to insulin administration, blood glucose monitoring (BGM), close attention to dietary intake and physical activity [13] doctor appointments, response to diabetic emergencies, etc. Studies have shown that the overall outcome of diabetes is improved by parental or caregiver management of their child’s diabetes-related tasks [14], [15]. In addition to other extenuating factors that contribute to good outcomes of diabetic management, caregivers must have basic knowledge on diabetes. Stallwood reported that “higher caregiver knowledge was associated with lower hemoglobin A 1c (HbA 1c) levels ….” and recommended “… ongoing knowledge assessments and educational interventions related to deficits, with a special focus on families in lower socioeconomic situations'' [16]. Similar significant improvement in diabetes knowledge was recorded with an online knowledge evaluation [17]. However, the literature is scanty when it comes to the impact of caregivers’ diabetes knowledge on the diabetic child school absences. The goal of this descriptive pilot study is two-fold: 1) to investigate the impact of caregiver’s basic diabetes knowledge on diabetic child school absenteeism and caregiver’s work absenteeism, and 2) to investigate the relationship between caregivers’ overall perception of their care activities and child school and caregiver’s work absenteeism. Results from this pilot study can be used to develop a more comprehensive investigation into the education of caregivers to enhance their diabetes management skills.
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