Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2024; 15(7): 1477-1488
Published online Jul 15, 2024. doi: 10.4239/wjd.v15.i7.1477
Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application
Wen-Hao Zhang, Chao-Fan Wang, Hao Wang, Jie Tang, Hong-Qiang Zhang, Jiang-Yu Zhu, Xue-Ying Zheng, Si-Hui Luo, Yu Ding
Wen-Hao Zhang, Hong-Qiang Zhang, Xue-Ying Zheng, Si-Hui Luo, Yu Ding, Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Chao-Fan Wang, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510000, Guangdong Province, China
Hao Wang, Jie Tang, Jiang-Yu Zhu, Graduate School, Bengbu Medical College, Bengbu 233000, Anhui Province, China
Co-first authors: Wen-Hao Zhang and Chao-Fan Wang.
Co-corresponding authors: Si-Hui Luo and Yu Ding.
Author contributions: Luo SH and Ding Y conceptualized and designed the research; Zhang WH and Wang CF conducted the data collection, analyzed data, and wrote the manuscript; Wang H, Tang J, Zhang HQ, Zhu JY provided insightful comments on the interpretation of the data, and the structure and revision of the manuscript; All authors read and revised the manuscript and approved the final manuscript. Zhang WH and Wang CF contributed equally to this work. Luo SH and Ding Y also contributed to study design, project administration and supervision, data interpretation, discussion of the results, and critical revision of the manuscript.
Supported by the Strategic Priority Research Program of Chinese Academy of Sciences, No. XDB38010100; the Natural Science Research Project of Anhui Educational Committee, No. 2023AH040398; Emergency Technological Research Project for COVID-19; and Science and Technology Projects in Guangzhou, No. 2023A04J1087.
Institutional review board statement: The institutional review board approved the study protocol at The First Affiliated Hospital of University of Science and Technology of China (No. 2019 KY-27).
Informed consent statement: Electronic informed consent was obtained from each participant and their parent or legal guardian, as applicable, before enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There are no additional data.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Ding, MD, Doctor, Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 96 Jinzhai Road, Hefei 230001, Anhui Province, China. yuding6815@163.com
Received: February 22, 2024
Revised: April 25, 2024
Accepted: May 20, 2024
Published online: July 15, 2024
Processing time: 136 Days and 17.2 Hours
Abstract
BACKGROUND

The glycemic control of children with type 1 diabetes (T1D) may be influenced by the economic status of their parents.

AIM

To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application.

METHODS

Data from children with T1D in China's largest T1D online community, Tang-TangQuan®. Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income. Children were divided into three groups: Low-income (< 30000 Yuan), middle-income (30000-100000 Yuan), and high-income (> 100000 yuan) (1 Yuan = 0.145 United States Dollar approximately). Blood glucose levels were compared among the groups and associations were explored using Spearman’s correlation analysis and multivariable logistic regression.

RESULTS

From September 2015 to August 2022, 1406 eligible children with T1D were included (779 female, 55.4%). Median age was 8.1 years (Q1-Q3: 4.6-11.6) and duration of T1D was 0.06 years (0.02-0.44). Participants were divided into three groups: Low-income (n = 320), middle-income (n = 724), and high-income (n = 362). Baseline hemoglobin A1c (HbA1c) levels were comparable among the three groups (P = 0.072). However, at month 36, the low-income group had the highest HbA1c levels (P = 0.036). Within three years after registration, glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups. Parental economic status was negatively correlated with pre-dinner glucose (r = -0.272, P = 0.012). After adjustment for confounders, parental economic status remained a significant factor related to pre-dinner glucose levels (odds ratio = 13.02, 95%CI: 1.99 to 126.05, P = 0.002).

CONCLUSION

The blood glucose levels of children with T1D were negatively associated with parental economic status. It is suggested that parental economic status should be taken into consideration in the management of T1D for children.

Keywords: Type 1 diabetes; Children and adolescents; Glycemic control; Economic status; Mobile health application

Core Tip: The study’s strength lies in its ability to capture an extended time frame of self-monitoring blood glucose data, reflecting glycemic control in children and adolescents with type 1 diabetes (T1D) across household income, using the mobile health application. As well as the study scenario was changed from a traditional single-center offline retrospective analysis to the largest T1D online community in China, "TangTangQuan®", to dynamically observe blood glucose changes in children registered for three years and provide experience for online support glucose management.