Health-Related Quality of Life and Diabetes Control in Immigrant and Italian Children and Adolescents with Type 1 Diabetes and in their Parents

Background/Objectives: Type 1 diabetes (T1D) is a chronic metabolic disease that requires daily and complex management for both patients and their caregivers, impairing the quality of life. Aim of this cross-sectional observational study was to determine whether metabolic control and health-related quality of life (HRQOL) of T1D subjects and their parents could be influenced by immigration status. Methods: We enrolled 125 children and adolescents with T1D (12.4±3.55 years; males 53.6%; T1D duration 5.61±3.50 years) and their parents (102 mothers and 37 fathers). According to patients’ maternal origin, the study population was categorized into Group A (immigrant) and Group B (Italian). The Italian translation of the PedsQL™ 3.0 Diabetes Module was used to evaluate the HRQOL. Information on presence of diabetic ketoacidosis (DKA) at T1D onset, insulin therapy (MDI/SAP), and glycosylate hemoglobin (HbA1c), were collected at the same time of the questionnaire. Results: Group A, respect to Group B, had significantly higher frequency of DKA at T1D onset (55.0 vs. 22.3%; Chi-square=13.1; p<0.001) and a significant lower use of SAP (5.0 vs. 22.3%; Chi-Square=5.86; p=0.015). HbA1c values were significantly higher in Group A respect to Group B (72.7±17.6 vs. 62.6±12.9 mmol/mol; p<0.001). Patients’ HRQOL scores were significantly lower in Group A than in Group B in the following scales: “Diabetes selfsymptoms” (57.9±14.6 vs. 66.9±12.8; p=0.004), “Treatment barriers” (68.1±23.6 vs. 82.9±13.0; p=0.001), and “Worry” (52.9±26.9 vs. 66.9±23.7; p=0.009). Mothers’ HRQOL scores were significantly lower in Group A than in Group B in the following scales: “Diabetes self-symptoms” (56.7±18.1 vs. 65.8±15.7; p=0.030), “Treatment barriers” (55.9±19.8 vs. 71.3±19.7; p<0.001), “Treatment adherence” (71.2±18.1 vs. 80.6±11.2; p=0.018), “Communication” (58.9±31.4 vs. 75.9±23.3; p=0.009) scales, and total score (57.2±17.1 vs. 68.8±12.6; p=0.011). No differences were found in fathers’ data. The multivariate regression model for child HRQOL scales identified the following significant predictive factors: MDI insulin therapy ('=0.438; p=0.008), Italian ethnicity ('=0.018; p=0.004), HbA1c ('=-0.228; p=0.029) for “Treatment barriers” scale; Italian ethnicity ('=0.584; p=0.046) for “Worry” scale. Conclusions: Our results strongly suggest that immigrant status confers significant disadvantages in terms of T1D treatment, glycemic control, and HRQOL in children and adolescents with T1D. Moreover, parents’ HRQOL data suggest that daily T1D management is usually supervised by mothers rather than fathers. Specific challenges and educational interventions should be considered in clinical care of T1D patients with distinct migration background.