The mediating effects of diabetes self-management on the relationship between diabetes distress and quality of life among school-age children with type 1 diabetes mellitus during the COVID-19 pandemic

Abstract

Background: Diabetes distress is prevalent among youth with type 1 diabetes mellitus (T1DM) and can negatively impact their quality of life and metabolic control. Identifying modifiable factors to reduce this distress is crucial. This study investigates the interplay between diabetes distress, self-management, and quality of life in school-aged children with T1DM amidst the COVID-19 pandemic. Its primary objective is to identify modifiable factors that can assist these children as they navigate the challenges associated with transitioning into adolescence. Methods: A cross-sectional study with data from 341 Chinese school-age children aged 8–12 was conducted. Data were collected through an online self-report survey during the COVID-19 pandemic (June–December 2022). The data included sociodemographic and clinical characteristics, diabetes distress, diabetes care activities and diabetes problem solving of diabetes self-management and quality of life. Structural equation modeling assessed relationships and mediation effects. Results: All four domains of diabetes distress exhibited negative associations with quality of life (r = −0.74 to −0.77, p < 0.01). Care activities and problem-solving related to diabetes self-management mediated the associations of emotional burden and regimen-related distress with quality of life (both p < 0.05). Conversely, neither diabetes care activities nor diabetes problem-solving mediated the relationship between physician-related distress and quality of life. Conclusions: Our findings indicate that problem-solving techniques related to diabetes self-management might be more effective at alleviating various aspects of diabetes distress—such as emotional burden, regimen-related distress, and interpersonal distress—compared to diabetes care activities. Interventions that teach structured problem-solving strategies could be beneficial. Given the ongoing pandemic, these findings could also serve as useful guidance for developing support strategies for school-age children with chronic conditions during future public health emergencies.