Elsevier

Eating Behaviors

Volume 14, Issue 4, December 2013, Pages 464-467
Eating Behaviors

Examining mealtime behaviors in families of young children with type 1 diabetes on intensive insulin therapy

https://doi.org/10.1016/j.eatbeh.2013.08.010Get rights and content

Highlights

  • Intensive insulin therapy allows for more flexible eating at mealtimes.

  • Young children on intensive insulin therapy were disruptive at mealtimes.

  • Parents of young children engaged in ineffective mealtime management strategies.

  • Children's disruptive behaviors relate child average glycemic control.

  • Families reporting mealtime problems should be referred for behavior therapy.

Abstract

This study examined mealtime behaviors in families of young children with type 1 diabetes (T1DM) on intensive insulin therapy. Behaviors were compared to published data for children on conventional therapy and examined for correlations with glycemic control. Thirty-nine families participated and had at least three home meals videotaped while children wore a continuous glucose monitor. Videotaped meals were coded for parent, child, and child eating behaviors using a valid coding system. A group difference was found for child request for food only. There were also associations found between children's glycemic control and child play and away. However, no associations were found between parent and child behaviors within meals and children's corresponding post-prandial glycemic control. Results reinforce existing research indicating that mealtime behavior problems exist for families of young children even in the context of intensive therapy and that some child behaviors may relate to glycemic control.

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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