ABSTRACT
OBJECTIVE: This study examined caregiver perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on a diverse sample of U.S. youth with diabetes and their families. METHODS: Caregivers of youth with diabetes completed an electronic survey in English or Spanish at two sites. Participants provided demographic and disease characteristics and completed the COVID-19 Exposure and Family Impact Scales (CEFIS). Glycemic health was assessed via Hemoglobin A1c (HbA1c) from medical chart review. Analysis of variance and analyses of covariance were utilized to examine racial/ethnic differences in glycemic health and in COVID-19 Exposure, Impact, and Distress scales. Hierarchical linear regression was conducted to predict HbA1c. Thematic analysis was conducted on open-ended responses regarding the effects of COVID-19 on youth and families' overall and diabetes-related well-being. RESULTS: Caregivers (n = 114) of youth with diabetes (M = 12.6 ± 3.5 years) completed study measures. Mean HbA1c for Non-Hispanic White youth was lowest and significantly different from Hispanic and Non-Hispanic Black youth. Exposure to COVID-19 stressors differed by race/ethnicity (p < .05) with Hispanic caregivers reporting greatest exposure. CEFIS scales did not predict HbA1c after controlling for demographic/disease variables. Caregivers described child/family changes during COVID (e.g., more time together, health-related hypervigilance), as well as differences in diabetes management during COVID-19. CONCLUSIONS: Findings indicate differences in COVID-19 exposure but did not demonstrate other racial/ethnic disparities in COVID-19 impact or distress. Household income was the most important predictor of glycemic health. Addressing structural inequalities experienced by youth with diabetes and their families is critical. Recommendations to support families with diabetes are made.
ABSTRACT
Background: Individuals with diabetes have been disproportionately affected by the COVID-19 pandemic. Data on the impact of COVID-19 on youth with T1D is scarce. We sought to determine the impact on youth with T1D and their families including the extent to which they experienced COVID-related disruptions and distress. Methods: The COVID-19 Exposure and Family Impact Survey (CEFIS) was administered to caregivers of youth with T1D at two comprehensive diabetes clinics in the northeast and southern U.S. Items were scored and analyzed using SPSS. Themes were coded for open-ended questions. Health data were extracted from EMR. Results: Mothers (85%) of 47 youth (72%NHW, 24%NHB, 4%H) with T1D (HbA1c M=8.3%) ranging from 6 to 17 years participated. Insulin pumps were used by 66% and CGMs by 17%. The most frequent COVID-related challenges endorsed were school/childcare closure (95.1%), education disruption (87.2%) and inability to visit/care for family (74.5%). Fewer caregivers reported difficulty accessing food (11.3%), necessary health care (9.4%), or medicine (5.7%). Areas of negative impact included child's access to medical supplies (2.6), physical activity level and diet (M=2.7), as well as caregiver anxiety (M =3.2), mood (M =2.8), sleeping, eating, and exercise (M=2.7). Caregivers reported COVID-related distress for themselves (M=5.8) and their child (M=5.0;scale 1-10). Common themes regarding the impact of COVID-19 were increased health anxiety, limited social interaction, and routine disruption. Caregivers noted benefits in family cohesion. Both positive and negative impact on diabetes management were described by caregivers. Quotes from caregivers will be presented. Conclusions: This ongoing study highlights early findings on the impact of COVID-19 on youth and families with T1D. Clinicians and researchers should consider the psychosocial impact of COVID-19 on youth with T1D and tailor diabetes care accordingly.