Examining mealtime behaviors in families of young children with type 1 diabetes on intensive insulin therapy
Introduction
Research demonstrates that parents of young children with type 1 diabetes (T1DM) perceive mealtimes as problematic and videotaped studies of home meals confirm the occurrence of disruptive child and ineffective parent behaviors (Patton et al., 2006, Patton et al., 2004, Powers et al., 2002). These early studies were conducted in samples of young children primarily following a conventional, twice daily injection regimen, which demands greater consistency in the timing and amount of food consumed (Patton et al., 2004, Patton et al., 2006, Powers et al., 2002, Silverstein et al., 2005). For young children with T1DM, an intensive insulin regimen involving multiple daily injections or an insulin pump is now the standard of care (Silverstein et al., 2005). Intensive therapy has the potential to be superior to conventional therapy because insulin is administered at the time of each food intake thus allowing for greater flexibility in eating. Greater flexibility in diet may translate into reduced parental perceptions of mealtime problems because parents are no longer required to meet a specific carbohydrate target at meals. Unfortunately, in a recent study of families of young children on intensive therapy, we found that parents still reported mealtime problems and that disruptive child behavior was positively correlated with average child blood glucose (Patton, Williams, Dolan, Chen, & Powers, 2009).
In this study, we expand upon the examination of mealtimes in families of young children with T1DM by comparing videotaped home meals for young children on intensive therapy to published data for children on conventional therapy (Patton et al., 2006). In addition, we examine whether family mealtime behaviors relate to children's glucose levels in the context of intensive therapy. Based on the extant literature, we tested the following hypotheses:
- 1.
Family mealtime behaviors for young children on intensive therapy will differ from published data for families of young children on conventional therapy.
- 2.
Young children who exhibit disruptive mealtime behaviors will have poor glycemic control.
- 3.
Parents who exhibit ineffective behaviors will have children in poor glycemic control.
- 4.
Controlling for carbohydrate intake and insulin, disruptive mealtime behaviors will positively correlate with children's post-prandial glycemic control.
- 5.
Controlling for carbohydrate intake and insulin, parents' use of ineffective behaviors will positively correlate with children's post-prandial glycemic control.
Section snippets
Participants
The sample consisted of 39 young children and a parent from two children's hospitals in the mid-western United States. Families were eligible to participate if they were English speaking and they had a child with T1DM who was less than 7 years old and following an intensive insulin regimen (e.g., insulin pump or multiple daily injections). Seventy-seven families were contacted about the study. Of these, 38 refused to participate because of time constraints and concerns about continuous glucose
Participants
Table 1 summarizes the sample characteristics.
Mealtime behaviors
Table 2 lists summary data for parent and child behavior during the videotaped home meals. The average meal length for the current sample was 21.5 ± 10.6 minutes, which was comparable to the published meal length (Patton et al., 2006). Contrary to hypothesis 1, parent and child behaviors were generally consistent with published data, with only one exception. In the present sample, children were observed to request food significantly more often than
Discussion
We contribute to the literature by using videotaped home meals to compare family mealtime behaviors in young children on intensive therapy versus published data for children on conventional therapy. We also use CGM to collect new data exploring associations between family mealtime behaviors and children's post-prandial glucose control. Failure to find broad differences in family mealtime behaviors based on children's insulin regimen (viz., intensive versus conventional) suggests that simply
Conclusions
Mealtime problems exist even in the context of intensive therapy. Our data suggest that within a typical meal children spend an average of 2 minutes away from the table and over 6 minutes talking, all which translate into less time eating. Behavior therapy can help to reduce the occurrence of mealtime problems and may be an important addition to diabetes education and routine care (Powers et al., 2005, Stark et al., 1994, Stark et al., 1993, Stark et al., 1996).
Role of funding source
Funding for this study was provided by grants K24-DK59973 and K23-DK076921 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases. NIH/NIDDK had no role in the study design, collection, analysis, or interpretation of the data, writing the article, or the decision to submit the paper for publication.
Contributors
Drs. Patton and Powers designed the study and wrote the protocol. Drs. Patton, Dolan, and Smith recruited families, collected the data, and managed all of the data. Dr. Brown conducted the statistical analysis. Dr. Patton wrote the first draft of the article and all authors contributed to and have approved the final article.
Conflict of interest
All of the authors declare that they have no conflicts of interest.
Acknowledgements
We extend special appreciation and thanks to the families who participated in this study. A portion of the data for this article was collected at the University of Michigan C.S. Mott Children's Hospital.
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