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DIABETIC _ SPECIFIC ROUTINES ASSESSMENT for ADOLESCENT with DIABETES MELLITUS TYPE 1 FROM PARENT PERSPECTIVE

    REYAM ABASS YASIR AFIFA RIDA AZIZ

Mosul Journal of Nursing, 2022, Volume 10, Issue 3, Pages 26-38
10.33899/mjn.2022.175358

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Abstract

Background and aim: A chronic illness impacts not just the patient, but also the family as a whole, and there is a lot to be gained by including the family in therapy. So, this study aims to assess diabetic-specific routines of adolescents with diabetes mellitus type 1 from the parent perspective andDifferences in Parent’report of Specific Diabetic routines with regard to their Socio-demographic variables.
 Methods: descriptive cross-sectional study design was carried out for the Assessment of Diabetes-Specific Routine for adolescents with Diabetes Mellitus Type 1 from the parent perspective in Diabetes and Endocrinology Center at Al- Nasiriya City from13th of October 2021 to 25th April, 2022 .  The sample consists (110)  parents selected through purposive sampling. The information was gathered through the use of self-administered instruments which are the diabetes-specific routine scale. The data were analyzed by using SPSS ver-20 and Microsoft Excel (2010) program.
 Results: the parents expressed a moderate response regards specific diabetic routine for adolescents with T1DM as indicated by moderate mean scores at all studied items of the scale except, the items number (1, 2, 3, 4, 12, 16, 17, 18, 19 and 20) the responses were poor
 Conclusion: (62.6%) of parents exhibited that the adolescent follows a routine on a moderate level
Keywords:
    ds:parents diabetes mellitus type 1 specific routine

DIABETIC _ SPECIFIC  ROUTINES  ASSESSMENT  for  ADOLESCENT  with DIABETES  MELLITUS TYPE 1 FROM PARENT PERSPECTIVE

REYAM ABASS YASIR1, AFIFA RIDA AZIZ2

  1. 1.    Master Student Department of Pediatric Nursing, College of Nursing, University of Baghdad
  2. 2.    Professor Doctor.At College of Nursing, University of Baghdad

 

Corresponding author: REYAM ABASS YASIR

Email: reym19302@gmail.com

ORCID:

ABSTRACT

Background and aim: A chronic illness impacts not just the patient, but also the family as a whole, and there is a lot to be gained by including the family in therapy. So, this study aims to assess diabetic-specific routines of adolescents with diabetes mellitus type 1 from the parent perspective andDifferences in Parent’report of Specific Diabetic routines with regard to their Socio-demographic variables.

 

Methods: descriptive cross-sectional study design was carried out for the Assessment of Diabetes-Specific Routine for adolescents with Diabetes Mellitus Type 1 from the parent perspective in Diabetes and Endocrinology Center at Al- Nasiriya City from13th of October 2021 to 25th April, 2022 .  The sample consists (110)  parents selected through purposive sampling. The information was gathered through the use of self-administered instruments which are the diabetes-specific routine scale. The data were analyzed by using SPSS ver-20 and Microsoft Excel (2010) program.

 

Results: the parents expressed a moderate response regards specific diabetic routine for adolescents with T1DM as indicated by moderate mean scores at all studied items of the scale except, the items number (1, 2, 3, 4, 12, 16, 17, 18, 19 and 20) the responses were poor

 

Conclusion: (62.6%) of parents exhibited that the adolescent follows a routine on a moderate level

 

Keywords:parents , diabetes mellitus type 1, specific routine

Received: 16 March 2022, Accepted: 26 May 2022, Available online: 28 August 2022

 


 


INTRODUCTION

 

Diabetes is a term that describes a set of disorders characterized by elevated blood glucose levels. It's caused by a lack of insulin production or action, or both, which can happen for a variety of reasons, leading to protein and lipid metabolic problems (Mobasseri et al., 2020). Globally, T1DM is one of the fastest-growing chronic diseases, accounting for 5 to 10% of all diabetes cases (Mansi & Aziz., 2021). In Iraq, the prevalence of type 1 diabetes mellitus was 159 per 100,000, similar to that in Saudi Arabia, lower than that in Kuwait, but higher than that in Turkey (Zalzala et al., 2020).

A chronic illness impacts not just the patient, but also the family as a whole, and there is a lot to be gained by including the family in therapy. A positive and supportive family atmosphere can help patients feel less stressed, and involving many family members in the condition's management can help patients stick to their medical regimen better (Crespo et al., 2013).

Routines and rituals within the family may be especially important in fostering stability during times of stress and transition. Childbirth with a chronic disease, or the start of a chronic condition in a previously healthy person in the family a significant shift for the family, one that is associated with increased pressure and burden for the entire family not only for the patient (Crespo et al., 2013).

Normal developing responsibilities (e.g., maturation, autonomy, increased freedom, and incomplete development of executive functioning) may restrict routines management for adolescents with T1D, whereas diabetes-specific routines occur when self-care specific tasks are achieved in a steady manner, time, and order (Pierce et al., 2019).

METHOD

A descriptive cross-sectional study design The study was conducted in Al Nasiriya City (Diabetes and Endocrinology Center) in Thi-Qar governorate, Iraq on parents of adolescents with diabetes mellitus type. The study started on 13th of October 2021 to 25th April, 2022. Nonrandomized (purposive) study of (110) parents. The Study Instrument Based on the diabetes-specific routine scale, the questionnaire was adopted and developed to assess diabetes-specific routine for parents of adolescents with diabetes (Pierce et al.,2019). This consists of 24-items and is measured on 4-point (Never, Rarely, Sometimes, and Always). To identify the overall parent for adolescent diabetic specific routine, the Mean for total score (Poor= 24-48; Moderate=48.1-72; Good=72.1-96). A Pilot study was done on 10 parents of the adolescent with diabetes mellitus recruited from the Diabetes and Endocrinology Center at Al- Nasiriya City between 13th October 2021 to 25th April, 2022 .  the inclusion criteria that use to select the sample the adolescent who are diagnosed with T1DM type 1, adolescents and their parents who are of different education and  adolescents who are both genders. But the exclusion criteria was adolescents who disagree to take part or refused to participate in the present study. The sample of the pilot study was excluded from  the total sample.  The reliability of study instruments was determined by using Alpha Cronbach test coefficient which revealed that r= (0.74).

SPSS version (20) and Microsoft Excel (2010) programs to statistically analyze the data collected from the study sample, find the relationships between the variables and obtain the research's final results based on a set of statistical tests.

RESULTS

 Table (1) shows (110) parents of type 1 diabetic adolescents who participated in this study their aged fathers and mothers ranged from 30-39 years old were 63 (57.3%) for each of them respectively social status-related findings, the majority of 96 (87.3%) study participants exhibited live together as compared with those who are separated 14 (12.7%). In regards to parents’ lives, it is obvious that the majority of the studied sample was alive, be it a father 100 (90.9%) or a mother 107 (97.3%) and residents in urban areas 88 (80%).In terms of education level, the fathers of adolescents were college graduates 40 (36.4%) as compared with adolescents’ mothers were illiterate 28 (25.5%). Monthly income associated findings, most of the study participants were make <300 thousand dinars 59 (53.6%) and Does not work 47 (42.7%).

Table (2) this table demonstrated that the parents expressed a moderate responses regards specific diabetic routine for adolescents with T1DM as indicated by moderate mean scores at all studied items of the scale except, the items number (1, 2, 3, 4, 12, 16, 17, 18, 19 and 20) the responses were poor as indicated by low mean scores, as well as, the items number (6, 8,  and 9) the responses were good as indicated by higher mean scores.

Table(3) According to the parents report of diabetic routine for adolescents with type I DM, findings illustrated that the (62.6%) of parents exhibited that the adolescent follow a routine on a moderate level

Table (4) Findings demonstrated that there were no significant differences in specific diabetic routines with regardto  fathers (p=0.214) and mothers (p=0.439) age groups.

Table (5) Findings demonstrated that there were significant differences in specific diabeticroutine wregardarto ds social state (t=5.084; p=0.000)between those who are live together (M=2.32) and those who are separated (M=1.63).

Table (6) Findings demonstrated that there were significant differences in specific diabetic routine with regard fathers (t=6.436; p=0.000); and no significant differences in specific diabetic routine with regard mothers (t=0.381; p=0.704).

Table (7) Findings demonstrated that there were no significant differences in specific diabetic routine with regards residents (p=0.064).

Table(8) Findings demonstrated that there were significant differences in specific diabetic routine with regard fathers education (p=0.000) and mothers education (p=0.000).

Table(9) Findings demonstrated that there were significant differences in specific diabetic routine with regard moto nthly income (p=0.00).

Table(10) Findings demonstrated that there were no significant differences in specific diabetic routine with regard parents occupation (p=0.713).


 

Table 1.Distributtion of Adolescents their Parents SDVs

 

SDVs

Classification

Freq.

%

Father Age

20-29 years

6

5.5

30-39 years

63

57.3

40-49 years

30

27.2

50 and older

11

10.0

Total

110

100.0

Mothers Age

<30 years

34

30.9

30-39 years

57

51.8

40-49 years

19

17.3

Total

110

100.0

Social Status of Parents

Together

96

87.3

Separated

14

12.7

Total

110

100.0

Fathers alive

Yes

100

90.9

No

10

9.1

Total

110

100.0

Mothers alive

Yes

107

97.3

No

3

2.7

Total

110

100.0

Residents

Urban

88

80.0

Rural

22

20.0

Total

110

100.0

Fathers education

Illiterate

15

13.6

Elementary school

22

20.0

Intermediate school

19

17.3

Secondary school

14

12.7

College and above

40

36.4

Total

110

100.0

Mothers education

Illiterate

28

25.5

Elementary school

23

20.9

Intermediate school

25

22.7

Secondary school

12

10.9

College and above

22

20.0

Total

110

100.0

Monthly income

<300 Thousand dinars

59

53.6

300-600 Thousand dinars

14

12.7

601-900 Thousand dinars

22

20.0

901-1,200 Thousand dinars

15

13.7

Total

110

100.0

Occupation

Does not work

47

42.7

Unskilled worker

27

24.5

Semi-skilled worker

24

21.9

Professional

12

10.9

Total

110

100.0

 

 

 

Table 2. Parents Report Diabetes-Specific Routine for Adolescents

 

List

Parents Report

Weighted

Freq.

%

M.s ±SD

Ass.

1

When my adolescent's blood sugar is high, he or she tests for ketones routinely.

Never

87

79.1

1.42±0.913

Poor

Rarely

7

6.4

Sometime

8

7.3

Always

8

7.3

2

My adolescent's diabetic supplies and medical prescriptions are refilled by following a routine.

Never

94

85.5

1.26±0.699

Poor

Rarely

6

5.5

Sometime

7

6.4

Always

3

2.7

3

The adolescent does not take her/his prescribed insulin either because he/she forgets or deliberately did not take it. 

Never

75

68.2

1.54±0.915

Poor

Rarely

17

15.5

Sometime

11

10.0

Always

7

6.4

4

When my adolescent is at school and has a low blood sugar level , he or she will be supervised routinely.

Never

90

81.8

1.46±1.037

Poor

Rarely

3

2.7

Sometime

3

2.7

Always

14

12.7

5

When my adolescent is away from home, he or she maintains adherence for his /her diabetic regimen by following a routine.

Never

39

35.5

2.61±1.361

Moderate

Rarely

13

11.8

Sometime

9

8.2

Always

49

44.5

6

My adolescent treats high blood glucose levels by following a routine such as administering more insulin and testing the glucose level after 2 hours

Never

11

10.0

3.48±1.002

Good

Rarely

8

7.3

Sometime

8

7.3

Always

83

75.5

7

My adolescent follows his or her plan of meals routinely.

Never

26

23.6

2.77±1.275

Moderate

Rarely

26

23.6

Sometime

5

4.5

Always

53

48.2

8

My adolescent calculates her/his dose of insulin routinely each time of snack or meal.

 

Never

11

10.0

3.46±0.925

Good

Rarely

0

0.0

Sometime

26

23.6

Always

73

66.4

9

My adolescent treats low blood sugars by following a routine such as testing glucose level, then eating tablets of glucose, waiting for 15 minutes, and then testing again.

 

Never

12

10.9

3.41±1.069

Good

Rarely

13

11.8

Sometime

2

1.8

Always

83

75.5

10

 My adolescent tests his/her blood glucose level routinely.

Never

19

17.3

3.00±1.192

Moderate

Rarely

20

18.2

Sometime

12

10.9

Always

59

53.6

11

When my adolescent is away from home such as in school, restaurants, or at a house of friends, family member’s house, He/ she plans for meals eaten in these places by following a routine routinely

Never

53

48.2

2.33±1.383

Moderate

Rarely

6

5.5

Sometime

12

10.9

Always

39

35.5

12

My adolescent consumes food that is not permitted to consume routinely.

 

Never

59

53.6

1.98±1.211

Poor

Rarely

16

14.5

Sometime

13

11.8

Always

22

20.0

13

My adolescent does not test her or his blood glucose level either because of forgetfulness or was on purpose

Never

49

44.5

2.32±1.321

Moderate

Rarely

10

9.1

Sometime

17

15.5

Always

34

30.9

14

My adolescent takes her/ his insulin by following a routine (either through injections or using an insulin pump machine). 

 

Never

14

12.7

3.36±1.114

Good

Rarely

13

11.8

Sometime

2

1.8

Always

81

73.6

15

My adolescent selects and rotates the pump or injection site by following a routine.

Never

26

23.6

2.88±1.239

Moderate

Rarely

13

11.8

Sometime

19

17.3

Always

52

47.3

16

Routinely before exercise, my adolescent prepares for the possibility of low glucose level occurrence such as eating snacks before doing exercise, decreasing the dose of insulin, and carrying the supplies needed to treat low glucose level.

Never

82

74.5

1.43±0.818

Poor

Rarely

11

10.0

Sometime

14

12.7

Always

3

2.7

17

My adolescent eats snacks by following a routine.

 

Never

53

48.2

1.91±1.014

Poor

Rarely

21

19.1

Sometime

28

25.5

Always

8

7.3

18

My adolescent plans for his/ her diabetes care on special occasions routinely such as sleepovers and parties such as a birthday party. 

Never

80

72.7

1.56±1.053

Poor

Rarely

13

11.8

Sometime

2

1.8

Always

15

13.6

19

At school, my adolescent adheres to her or his diabetic regimen by following a routine.

 

Never

70

63.6

1.98±1.361

Poor

Rarely

4

3.6

Sometime

4

3.6

Always

32

29.1

20

My adolescent accesses diabetes equipment or school’s emergency supplies by following a routine.

Never

105

95.5

1.06±0.311

Poor

Rarely

3

2.7

Sometime

2

1.8

Always

0

0.0

21

When my adolescent is out of the house, he or she always carries emergency supplies such as glucose pills that are needed for treating low glucose level.

 

Never

51

46.4

2.22±1.296

Moderate

Rarely

14

12.7

Sometime

14

12.7

Always

31

28.2

22

While my adolescent is participating in extracurricular activities such as clubs or sports, he/she adheres to his/her diabetes regimen by following a routine.

 

Never

70

63.6

2.03±1.394

Moderate

Rarely

0

0.0

Sometime

6

5.5

Always

34

30.9

23

While my adolescent is spending time at our house with friends, he or she adheres to his/ her diabetes regimen by following a routine. 

 

Never

62

56.4

2.13±1.357

Moderate

Rarely

3

2.7

Sometime

13

11.8

Always

32

29.1

24

While my adolescent is spending time away from home with friends, he/ she adheres to his or her diabetes regimen by following a routine. 

Never

62

56.4

2.06±1.308

Moderate

Rarely

7

6.4

Sometime

13

11.8

Always

28

25.5

"(MS) Mean of Scores, (SD) Standard deviation, Level of Assessment (Poor=1-2, Moderate=2.1-3, Good= 3.1-4)"

 

 

Table 3. Overall Parents Report for Adolescents Diabetes-Specific Routine

Routine for T1DM

Freq.

%

M ± SD

Poor Routine

30

27.3

53.78±12.78

Moderate Routine

70

63.6

Good Routine

10

9.1

Total

110

100.0

M: Mean for total score, SD=Standard Deviation for total score

(Poor= 24-48; Moderate=48.1-72; Good=72.1-96)

 

 

Table 4. Statistical Differences in Specific Diabetic Routine with regards Parents Age (n=110)

 

Specific-Diabetic Routine

Source of variance

Sum of Squares

d.f

Mean Square

F

Sig.

Fathers Age

Between Groups

1.273

3

.424

1.518

.214

Within Groups

29.638

106

.280

Total

30.911

109

 

Mothers Age

Between Groups

.472

2

.236

.829

.439

Within Groups

30.439

107

.284

Total

30.911

109

 

d.f: Degree of freedom, F: F-statistic.

Table( 5)Statistical Differences in Specific Diabetic Routine with regards Parents Social Status(n=110)

 

Diabetes-Specific Routine

Social Status

Mean

SD

t-value

d.f

Sig.

Together

2.32

.467

5.084

108

.000

Separated

1.63

.564

SD: Standard deviation, t: t-test, d.f: Degree of freedom, p: Probability value.

Table( 6)Statistical Differences in Specific Diabetic Routine with regards Parents Alive (n=110)

 

Diabetes-Specific Routine

Rating

Mean

SD

t-value

d.f

Sig.

Father Alive

Yes

2.32

.450

6.436

108

.000

No

1.35

.497

Mothers Alive

Yes

2.24

.539

.381

108

.704

No

2.12

.000

SD: Standard deviation, t: t-test, d.f: Degree of freedom, p: Probability value

Table (7)Statistical Differences in Specific Diabetic Routine with regards Parents Residents (n=110)

 

Diabetes-Specific Routine

Residents

Mean

SD

t-value

d.f

Sig.

Urban

2.28

.525

1.871

108

.064

Rural

2.05

.531

Table(8) Statistical Differences in Specific Diabetic Routine with regards Parents Education (n=110)

Specific-Diabetic Routine

Source of variance

Sum of Squares

d.f

Mean Square

F

Sig.

Fathers Education

Between Groups

16.318

4

4.079

29.352

.000

Within Groups

14.593

105

.139

Total

30.911

109

 

Mothers Education

Between Groups

7.946

4

1.986

9.082

.000

Within Groups

22.965

105

.219

Total

30.911

109

 

 

Table(9)Statistical Differences in Specific Diabetic Routine with regards Parents Education (n=110)

 

Specific-Diabetic Routine

Source of variance

Sum of Squares

d.f

Mean Square

F

Sig.

Monthly Income

Between Groups

5.848

3

1.949

8.244

.000

Within Groups

25.063

106

.236

Total

30.911

109

 

 

 

Table (10)Statistical Differences in Specific Diabetic Routine with regards to Parents Occupation (n=110)

Specific-Diabetic Routine

Source of variance

Sum of Squares

d.f

Mean Square

F

Sig.

Occupation

Between Groups

.394

3

.131

.457

 

 

 

Within Groups

30.517

106

.288

Total

30.911

109

 

 

 

 

 

DISCUSSION

Regarding to the study sample of (110) parents of type 1 diabetic adolescents who participated in this study their aged fathers and mothers ranged 30-39 years old were 63 (57.3%) for each them respectively  Regarding this results are nearly agree with study done in iraq  by Shukur et al., (2021) which revealed that fathers,  58%  were  >  35  years  old and mother ,  51.6 %  were  >  35  years  old, is results not agree with study done by  de Beaufort et al., (2021) mean diabetes period: 3 ± 1.7 years) participated. 23/24 parents Related to social status related findings, the majority of 96 (87.3%) study participants exhibited live together as compared with those who are separated 14 (12.7%) these results is supported by study done in Iraq by Naser, ( 2019) which revealed that the majoerty of study sample social status were marriage and account more that (90.0%) of all study sample mother and father also there is no related international studies for spported this results.

In regards with parents live, it is obvious that the majority of studied sample were alive, be it a father 100 (90.9%) or a mother 107 (97.3%) and residents in urban areas 88 (80%).

In terms of education level, the fathers of adolescents were college graduated 40 (36.4%) as compared with adolescents mothers were illiterate 28 (25.5%)these results is agree with study done by (Naser, 2019) which revealed that the majorty of study sample father and mather at secondary school 38.0 and 33.0 respectively  these results are not agreement with study done by  Tao et al., (2017)which revealed that whose parents had an educational level of senior high school or below.

Monthly income associated findings, most of study participants were make <300 thousand dinars 59 (53.6%) and Does not work 47 (42.7%).this results are not consienet with the study done by Thomas et al., (2018) Median annualy of family income ranged from $70,000 to $99,999. lesser adherence less insulin use, , and poorer glycemic control connected with Lower family income. Bivariate links with income,  parenting variables and glycemic control adherence.

Regarding to this table (2and 3) demonstrated that the parents expressed a moderate responses regards specific diabetic routine for adolescents with T1DM as indicated by moderate mean scores at all studied items of the scale except, the items number (1, 2, 3, 4, 12, 16, 17, 18, 19 and 20) the responses were poor as indicated by low mean scores, as well as, the items number (6, 8, and 9 ) the responses were good as indicated by higher mean scores. According to the parents report of diabetic routine for adolescents with type I DM, findings illustrated that the (62.6%) of parents exhibited that the adolescent follow a routine on a moderate level as described by moderate mean score (±SD) = 53.78 (±12.78) these results spported by  Ouzouni et al., (2018)  mention that adolescent  sensed more supported by their families. Overweight teenagers (p = -.333, r =.018), as well as taller respondents (p = -.323, r =.022), received less support for of  insulin. Over all Respondents who use additional insulin units felt less supported (p = -.268, r = .047) and during  blood checks (p = -.290, r = .034). Adolescents who took more blood glucose readings felt less supported when it came to their meal plan (p =-.307, r =.028), which they followed only seldom (p =-.322, r =.023). also agreement with   study done by  Moore et al., (2013) which revealed tha Parent-reported family dysfunction, as well as the impact of illness on the family system and parental stress, were all high.  greater adolescent behavioral issues, Lower levels of family functioning, and worse teenage mental wellbeing were linked to higher HbA1c (poor metabolic management) and less appropriate adolescent self-care.

The analysis of variance showed that there were no-significant differences in specific diabetic routine with regard fathers (p=0.214) and mothers (p=0.439) age groups (table 4-9-1). Because no matter how old or young the age, parents still care for their adolescents, so age is an ineffective factor in caring for children with diabetes. The absence of moral differences indicates that parents, regardless of their age, provide the same diabetes-related care for their children. Previous studies also reached our conclusion that age is not a factor affecting diabetes routine between parents and children or adolescents.

This findings is supported by Streisand & Monaghan (2014), who confirmed in their findings that the parent age is not considered an influential factor in the diabetes challenges facing their children, as they do everything they have to take care of their children with diabetes without restricting their age. Another, confirmed that there were no differences in diabetic children and parents age in terms of diabetic management (Laroche et al., 2009). As well as, there were no correlation between daily activities of living among children with diabetes mellitus and their parents age (Zysberg & Lang, 2015).

According to Parents Report of Specific Diabetic Routine and their Social State Findings demonstrated that there were significant differences in specific diabetic routine with regards social state (t=5.084; p=0.000) between those who are live together (M=2.32) and those who are separated (M=1.63) (table 4-9-2). In terms of the care that a teenager receives, there is a difference between the one whose parents live together and those who are separated (Fig. 4-3). A diabetic teen whose parents live together receives a much better routine than a teen whose parents live separately.

This findings com in agreement with findings of Kimbell et al. (2021), it was confirmed in their results that there are differences in the care of young children with diabetes and the marital status of their parents (the differences were in favor of those who live together in terms of attention and neglect from the separated). The effect of the parents' social status positively affects their living together in improvement children diabetes mellitus and negatively affects their separation (Jacquez et al., 2008). Peters et al. (2011), stated that the children with type I DM receive inadequate diabetes management support in terms of together and separated parents. Parental separation negatively affects young children and adolescents in managing diabetes (Delamater et al., 2018).

According to Parents Report of Specific Diabetic Routine and its Life Findings demonstrated that there were significant differences in specific diabetic routine with regard fathers (t=6.436; p=0.000); and no significant differences in specific diabetic routine with regard mothers (t=0.381; p=0.704) (table 4-9-3). The loss of the father is considered an influencing factor in the diabetic routine, as the mother alone cannot provide a routine for her child, only the interest in his life and school matters. So there is a highly difference in the diabetic routine between those whose father lives and those who do not (Fig. 4-4). This findings come in line with findings of Banks et al. (2020), there are challenges in managing diabetes among children, depending on the participation of parents in order to take care of their child’s condition, and that the loss of one of the parents is a factor that negatively affects the management of diabetes.

According to Parents Report of Specific Diabetic Routine and their Residents There is no difference in the diabetic routine  (t= 1.871; p=0.064) between those who live in urban areas (M=2.28) and those who live in rural areas (M=2.05). Housing is not considered an important factor in the results, and it cannot be worked on in improving the diabetic routine (table 4-9-4). This findings com consisting with Pierce (2013), showed that the residents factors not associated with diabetic improve routine. There is no diabetic routine among those who live in the countryside or the countryside (ADA, 2012).

According to Parents Report of Specific Diabetic Routine and their Education Level The analysis of variance (ANOVA) showed that there were significant differences in specific diabetic routine with regard fathers education (p=0.000) and mothers education (p=0.000) (table 4-9-5). Through the results, college and above is significantly associated with better specific diabetic routine among both parents "fathers (Fig. 4-5) and mothers (Fig. 4-6)". There were significant association between diabetic routine and parent education as confirmed by Jaser (2011), the higher education is significantly associated with improved diabetic routine. Parents cannot support their children diabetic due to lack of knowledge and low level of education (Ouzouni et al., 2018). A poor diabetic routine is significantly associated with low education level among parents (Dedov et al., 2018).

According to Parents Report of Specific Diabetic Routine and their Income Findings demonstrated that there were significant differences in specific diabetic routine with regard monthly income (p=0.00) (table 4-9-6). The differences were in favour parents who 9000-1200 Thousand dinars/ month (Fig. 4-7), because they can meet the requirements of routine, economic status plays an important role in meeting diabetes-related needs.

There were poor perspective in diabetic routine among parents diabetic children due to poor economic status (Mellin et al., 2014). Parents cannot be relied upon to manage diabetes because of the poor economic situation (Levitsky & Misra, 2020). There were significant correlation (positive) between diabetic specific routine and economic status "poor diabetic routine associated with poor economic status" (Moore et al., 2013).

According to Parents Report of Specific Diabetic Routine and their Occupation Findings demonstrated that there were no significant differences in specific diabetic routine with regard parents occupation (p=0.713) (table 4-9-7). The diabetic specific routine not influenced by parents occupation because no matter how many professions, parents give everything they have to meet the needs of their children with diabetes. This findings is supported previous studies confirmed that the occupation no associated with diabetic routine and management (Trubey et al. 2015; Hassan et al., 2017; Goethals et al., 2021).

 

 

CONCLUSIONS

according to the parent’s report of diabetic routine for adolescents with TIDM, about (62.6%) of adolescents follow the routine on a moderate level.

 

ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES

Participent were informed about the current study and its aims, and then verbal consent was obtained from participants to participate in the study. Also,told that they have the right to agree or refuse to participate in the study. Regarding confidentiality and anonymity of participants, ethical approval was obtained from the ethical committee of research in the faculty of Nursing/ University of Baghdad.

 

FUNDING

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’SCONTRIBUTIONS

Study concept; Writing the original draft; Data collection; Data analysis and Reviewing the final edition by all authors.

DISCLOSURESTATEMENT: The authors report no conflict of interest.

REFERENCES

American Diabetes Association. (2012). Diabetes management at camps for children with diabetes. Diabetes Care, 35(Supplement_1), S72-S75.‏

Banks, G. G., Berlin, K. S., Keenan, M. E., Cook, J., Klages, K. L., Rybak, T. M., ... & Eddington, A. (2020). How peer conflict profiles and socio-demographic factors influence type 1 diabetes adaptation. Journal of pediatric psychology, 45(6), 663-672.‏

Crespo, C., Santos, S., Canavarro, M. C., Kielpikowski, M., Pryor, J., & Féres-Carneiro, T. (2013). Family routines and rituals in the context of chronic conditions: A review. International Journal of Psychology, 48(5), 729-746.  http://dx.doi.org/10.1080/00207594.2013.80681

Dedov, I. I., Shestakova, M. V., Peterkova, V. A., Vikulova, O. K., Zheleznyakova, A. V., Isakov, M. А., ... & Shiryaeva, T. Y. (2018). Diabetes mellitus in children and adolescents according to the Federal diabetes registry in the Russian Federation: dynamics of major epidemiological characteristics for 2013–2016. Diabetes mellitus, 20(6), 392-402.‏

Delamater, A. M., de Wit, M., McDarby, V., Malik, J. A., Hilliard, M. E., Northam, E., & Acerini, C. L. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatric diabetes, 19, 237-249.‏

Goethals, E. R., Volkening, L. K., & Laffel, L. M. (2021). Executive dysfunction is associated with poorer health-related quality of life in adolescents with type 1 diabetes: differences by sex. Quality of Life Research, 30(3), 751-758.

Hassan, M., Musa, N., Hai, R. A., Fathy, A., & Ibrahim, A. (2017). Assessment of health-related quality of life in Egyptian adolescents with type 1 diabetes: DEMPU survey. Journal of Pediatric Endocrinology and Metabolism, 30(3), 277-283.‏

Jacquez, F., Stout, S., Alvarez-Salvat, R., Fernandez, M., Villa, M., Sanchez, J., ... & Delamater, A. (2008). Parent perspectives of diabetes management in schools. The Diabetes Educator, 34(6), 996-1003.‏

Jaser, S. S. (2011). Family interaction in pediatric diabetes. Current Diabetes Reports, 11(6), 480-485.‏

Kimbell, B., Lawton, J., Boughton, C., Hovorka, R., & Rankin, D. (2021). Parents’ experiences of caring for a young child with type 1 diabetes: a systematic review and synthesis of qualitative evidence. BMC pediatrics, 21(1), 1-13.‏

Laroche, H. H., Davis, M. M., Forman, J., Palmisano, G., Reisinger, H. S., Tannas, C., ... & Heisler, M. (2009). Children's roles in parents' diabetes self-management. American Journal of Preventive Medicine, 37(6), S251-S261.‏

Levitsky, L. L., & Misra, M. (2020). Overview of the management of type 1 diabetes mellitus in children and adolescents. UpToDate [Internet].‏

Mansi, Q., & Aziz, A. (2021). Detect of Vitamin-D Deficiency in Children Under Five Years with Type 1 Diabetes Mellitus at Diabetes and Endocrinology Center in Al-Nasiriya City. Kufa Journal for Nursing Sciences, 11(1), 1-9.‏

Mellin, A. E., Neumark-Sztainer, D., & Patterson, J. M. (2004). Parenting adolescent girls with type 1 diabetes: parents' perspectives. Journal of pediatric psychology, 29(3), 221-230.‏

Mobasseri, M., Shirmohammadi, M., Amiri, T., Vahed, N., Fard, H. H., & Ghojazadeh, M. (2020). Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health promotion perspectives, 10(2), 98.‏

Moore, S. M., Hackworth, N. J., Hamilton, V. E., Northam, E. P., & Cameron, F. J. (2013). Adolescents with type 1 diabetes: parental perceptions of child health and family functioning and their relationship to adolescent metabolic control. Health and quality of life outcomes, 11(1), 1-8.‏

Naser, A. M. (2019). Determination of Parents Burnout for Child with Type 1 Diabetes Mellitus in Endocrine and Diabetes Center at Al-Nasiriyah City. Journal of Global Pharma Technology, 11(03), 565–569. www.jgpt.co.in

Ouzouni, A., Galli-Tsinopoulou, A., Kazakos, K., Dimopoulos, E., Kleisarchaki, A. N., Mouzaki, K., & Lavdaniti, M. (2018). The Intervention of Parents in Supporting of Diabetes Type 1 in Adolescents. Materia Socio-Medica, 30(2), 98.‏

Pedrosa, K. D. A., Pinto, J. T. J. M., Arrais, R. F., Machado, R. C., & Mororó, D. D. S. (2016). Education effectiveness in diabetes mellitus type 1 management made by children’s caregivers. Enfermería Global, 15(44), 115-126.‏

Peters, A., Laffel, L., & American Diabetes Association Transitions Working Group. (2011). Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American diabetes association, with representation by the American College of osteopathic family physicians, the American Academy of pediatrics, the American association of clinical endocrinologists, the American osteopathic association, the centers for disease control and prevention, children with diabetes, the endocrine Society, the International Society for .... Diabetes care, 34(11), 2477-2485.‏

Pierce, J. S. (2013). Examination of the pediatric diabetes routines questionnaire in adolescents: Development of an adolescent self-report version and confirmatory factor analysis. The University of Southern Mississippi.‏

Pierce, J. S., Jordan, S. S., & Arnau, R. C. (2019). Development and validation of the pediatric diabetes routines questionnaire for adolescents. Journal of clinical psychology in medical settings, 26(1), 47-58. https://doi.org/10.1007/s10880-018-9563-x.

Streisand, R., & Monaghan, M. (2014). Young children with type 1 diabetes: challenges, research, and future directions. Current diabetes reports, 14(9), 1-9.‏

Tao, N., Wang, A. P., Sun, M. Y., Zhang, H. H., & Chen, Y. Q. (2017). [An investigation of ketoacidosis in children with newly diagnosed type 1 diabetes]. Zhongguo Dang Dai Er Ke Za Zhi = Chinese Journal of Contemporary Pediatrics, 19(10), 1066–1069. https://doi.org/10.7499/J.ISSN.1008-8830.2017.10.007

Thomas, D. M., Lipsky, L. M., Liu, A., & Nansel, T. R. (2018). Income Relates to Adherence in Youth with Type 1 Diabetes Through Parenting Constructs. Journal of Developmental and Behavioral Pediatrics : JDBP, 39(6), 508. https://doi.org/10.1097/DBP.0000000000000579

Trubey, R. J., Moore, S. C., & Chestnutt, I. G. (2015). Children's toothbrushing frequency: the influence of parents' rationale for brushing, habits and family routines. Caries research, 49(2), 157-164.‏‏

Zalzala, S. H., Al-Lami, F. H., & Fahadc, K. S. (2020). Epidemiological profile of type 1 diabetes among primary school children in Baghdad, Iraq. J Contemp Med Sci| Vol, 6(1), 13-16.

Zysberg, L., & Lang, T. (2015). Supporting parents of children with type 1 diabetes mellitus: A literature review. Patient Intelligence, 7, 21-31

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(2022). DIABETIC _ SPECIFIC ROUTINES ASSESSMENT for ADOLESCENT with DIABETES MELLITUS TYPE 1 FROM PARENT PERSPECTIVE. Mosul Journal of Nursing, 10(3), 26-38. doi: 10.33899/mjn.2022.175358
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DIABETIC _ SPECIFIC ROUTINES ASSESSMENT for ADOLESCENT with DIABETES MELLITUS TYPE 1 FROM PARENT PERSPECTIVE. Mosul Journal of Nursing, 2022; 10(3): 26-38. doi: 10.33899/mjn.2022.175358
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American Diabetes Association. (2012). Diabetes management at camps for children with diabetes. Diabetes Care, 35(Supplement_1), S72-S75.‏

Banks, G. G., Berlin, K. S., Keenan, M. E., Cook, J., Klages, K. L., Rybak, T. M., ... & Eddington, A. (2020). How peer conflict profiles and socio-demographic factors influence type 1 diabetes adaptation. Journal of pediatric psychology, 45(6), 663-672.‏

Crespo, C., Santos, S., Canavarro, M. C., Kielpikowski, M., Pryor, J., & Féres-Carneiro, T. (2013). Family routines and rituals in the context of chronic conditions: A review. International Journal of Psychology, 48(5), 729-746.  http://dx.doi.org/10.1080/00207594.2013.80681

Dedov, I. I., Shestakova, M. V., Peterkova, V. A., Vikulova, O. K., Zheleznyakova, A. V., Isakov, M. А., ... & Shiryaeva, T. Y. (2018). Diabetes mellitus in children and adolescents according to the Federal diabetes registry in the Russian Federation: dynamics of major epidemiological characteristics for 2013–2016. Diabetes mellitus, 20(6), 392-402.‏

Delamater, A. M., de Wit, M., McDarby, V., Malik, J. A., Hilliard, M. E., Northam, E., & Acerini, C. L. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatric diabetes, 19, 237-249.‏

Goethals, E. R., Volkening, L. K., & Laffel, L. M. (2021). Executive dysfunction is associated with poorer health-related quality of life in adolescents with type 1 diabetes: differences by sex. Quality of Life Research, 30(3), 751-758.

Hassan, M., Musa, N., Hai, R. A., Fathy, A., & Ibrahim, A. (2017). Assessment of health-related quality of life in Egyptian adolescents with type 1 diabetes: DEMPU survey. Journal of Pediatric Endocrinology and Metabolism, 30(3), 277-283.‏

Jacquez, F., Stout, S., Alvarez-Salvat, R., Fernandez, M., Villa, M., Sanchez, J., ... & Delamater, A. (2008). Parent perspectives of diabetes management in schools. The Diabetes Educator, 34(6), 996-1003.‏

Jaser, S. S. (2011). Family interaction in pediatric diabetes. Current Diabetes Reports, 11(6), 480-485.‏

Kimbell, B., Lawton, J., Boughton, C., Hovorka, R., & Rankin, D. (2021). Parents’ experiences of caring for a young child with type 1 diabetes: a systematic review and synthesis of qualitative evidence. BMC pediatrics, 21(1), 1-13.‏

Laroche, H. H., Davis, M. M., Forman, J., Palmisano, G., Reisinger, H. S., Tannas, C., ... & Heisler, M. (2009). Children's roles in parents' diabetes self-management. American Journal of Preventive Medicine, 37(6), S251-S261.‏

Levitsky, L. L., & Misra, M. (2020). Overview of the management of type 1 diabetes mellitus in children and adolescents. UpToDate [Internet].‏

Mansi, Q., & Aziz, A. (2021). Detect of Vitamin-D Deficiency in Children Under Five Years with Type 1 Diabetes Mellitus at Diabetes and Endocrinology Center in Al-Nasiriya City. Kufa Journal for Nursing Sciences, 11(1), 1-9.‏

Mellin, A. E., Neumark-Sztainer, D., & Patterson, J. M. (2004). Parenting adolescent girls with type 1 diabetes: parents' perspectives. Journal of pediatric psychology, 29(3), 221-230.‏

Mobasseri, M., Shirmohammadi, M., Amiri, T., Vahed, N., Fard, H. H., & Ghojazadeh, M. (2020). Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health promotion perspectives, 10(2), 98.‏

Moore, S. M., Hackworth, N. J., Hamilton, V. E., Northam, E. P., & Cameron, F. J. (2013). Adolescents with type 1 diabetes: parental perceptions of child health and family functioning and their relationship to adolescent metabolic control. Health and quality of life outcomes, 11(1), 1-8.‏

Naser, A. M. (2019). Determination of Parents Burnout for Child with Type 1 Diabetes Mellitus in Endocrine and Diabetes Center at Al-Nasiriyah City. Journal of Global Pharma Technology, 11(03), 565–569. www.jgpt.co.in

Ouzouni, A., Galli-Tsinopoulou, A., Kazakos, K., Dimopoulos, E., Kleisarchaki, A. N., Mouzaki, K., & Lavdaniti, M. (2018). The Intervention of Parents in Supporting of Diabetes Type 1 in Adolescents. Materia Socio-Medica, 30(2), 98.‏

Pedrosa, K. D. A., Pinto, J. T. J. M., Arrais, R. F., Machado, R. C., & Mororó, D. D. S. (2016). Education effectiveness in diabetes mellitus type 1 management made by children’s caregivers. Enfermería Global, 15(44), 115-126.‏

Peters, A., Laffel, L., & American Diabetes Association Transitions Working Group. (2011). Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American diabetes association, with representation by the American College of osteopathic family physicians, the American Academy of pediatrics, the American association of clinical endocrinologists, the American osteopathic association, the centers for disease control and prevention, children with diabetes, the endocrine Society, the International Society for .... Diabetes care, 34(11), 2477-2485.‏

Pierce, J. S. (2013). Examination of the pediatric diabetes routines questionnaire in adolescents: Development of an adolescent self-report version and confirmatory factor analysis. The University of Southern Mississippi.‏

Pierce, J. S., Jordan, S. S., & Arnau, R. C. (2019). Development and validation of the pediatric diabetes routines questionnaire for adolescents. Journal of clinical psychology in medical settings, 26(1), 47-58. https://doi.org/10.1007/s10880-018-9563-x.

Streisand, R., & Monaghan, M. (2014). Young children with type 1 diabetes: challenges, research, and future directions. Current diabetes reports, 14(9), 1-9.‏

Tao, N., Wang, A. P., Sun, M. Y., Zhang, H. H., & Chen, Y. Q. (2017). [An investigation of ketoacidosis in children with newly diagnosed type 1 diabetes]. Zhongguo Dang Dai Er Ke Za Zhi = Chinese Journal of Contemporary Pediatrics, 19(10), 1066–1069. https://doi.org/10.7499/J.ISSN.1008-8830.2017.10.007

Thomas, D. M., Lipsky, L. M., Liu, A., & Nansel, T. R. (2018). Income Relates to Adherence in Youth with Type 1 Diabetes Through Parenting Constructs. Journal of Developmental and Behavioral Pediatrics : JDBP, 39(6), 508. https://doi.org/10.1097/DBP.0000000000000579

Trubey, R. J., Moore, S. C., & Chestnutt, I. G. (2015). Children's toothbrushing frequency: the influence of parents' rationale for brushing, habits and family routines. Caries research, 49(2), 157-164.‏‏

Zalzala, S. H., Al-Lami, F. H., & Fahadc, K. S. (2020). Epidemiological profile of type 1 diabetes among primary school children in Baghdad, Iraq. J Contemp Med Sci| Vol, 6(1), 13-16.

Zysberg, L., & Lang, T. (2015). Supporting parents of children with type 1 diabetes mellitus: A literature review. Patient Intelligence, 7, 21-31

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