Health-related quality of life and its influencing factors in children with type 1 diabetes in Tunisia: a cross-sectional study

Abstract

Objectives 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. Design This was a cross-sectional study. Setting The study was conducted at a tertiary care paediatric hospital in Tunis, Tunisia, over a 6-month period from November 2022 to April 2023. Participants A total of 120 children with T1DM, aged 3–17 years, and their parents were enrolled. Inclusion criteria included children with a confirmed diagnosis of T1DM and regular follow-up at the study centre. Outcome measures 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. Results We included 120 children with T1DM. HRQoL was considered satisfactory in 94 children (78.3%), with a mean total score of 69±20.8 (range: 21.4–99.3). Parents reported significantly lower HRQoL scores compared with their children’s self-assessments, with a mean total score of 59.2±20.4 (range: 14.3–97.5). Multivariate linear regression analysis identified several factors independently associated with impaired HRQoL, including a glycated haemoglobin level >9%, a child’s age greater than 14 years, a history of ketoacidosis decompensation, a daily insulin dose ≥0.78 IU/ 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. Conclusions 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.