Background: Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents’ skills to deal with electronic health information sources. Objective: We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children’s outcomes. Methods: A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents’ electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children’s treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. Results: Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents’ average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children’s treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=−0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children’s HbA1c (r=−0.143; P=.08), PedsQL Diab (r=−0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=−0.13; P=.12). Regression analysis revealed significant associations of the child’s HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=−0.66; P=.03; pump + sensor: β=−0.93; P=.007), and parents’ self-efficacy (PSESDM; β=−0.08; P=.001). Conclusions: Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents’ diabetes management attitude but not with the child’s glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.

Background/Objectives: Parental involvement is essential in managing type 1 diabetes mellitus (T1DM) in children, particularly with the growing use of continuous glucose monitoring (CGM). Validated tools assessing parental self-efficacy in this context remain limited. This study aimed to validate the Parental Self-Efficacy Scale for Diabetes Management (PSESDM) among parents of children using a CGM sensor and to examine its associations with diabetes outcomes and parental characteristics. Methods: A cross-sectional study was conducted involving 106 parent–child dyads at a university pediatric diabetes center. Parents completed the Hungarian PSESDM. Data regarding children’s HbA1c level were recorded, along with standard measures of their general and diabetes-specific quality of life (EQ-5D-Y-3L, PedsQL Diab); data regarding parents’ health literacy (Chew), fear of hypoglycemia (HFS), health-related quality of life (EQ-5D-5L), and capability well-being (ICECAP-A) were also collected. The PSESDM’s reliability, internal consistency, and discriminant and criterion validity were assessed using standard statistical methods. Results: The PSESDM demonstrated good internal consistency (Cronbach’s α = 0.857) and strong item–total correlations (range: 0.678–0.791). Higher parental self-efficacy was significantly associated with better glucose control (lower HbA1c, r_s = −0.50) and weakly correlated with the child’s diabetes-specific quality of life (r_s = 0.20). Among parental characteristics, self-efficacy correlated strongly with capability well-being (r_s = 0.52), moderately with health literacy (r_s = −0.30), and showed no difference between socio-demographic subgroups, except for the subgroup related to income. Conclusions: The PSESDM is a valid and reliable tool for measuring self-efficacy in parents of children with T1DM using CGM sensors. Its associations with children’s HbA1c levels, diabetes-specific quality of life, and parental characteristics support its clinical relevance and potential use in identifying families at risk for poorer diabetes outcomes.

Introduction: The prevalence of both obesity and type 1 diabetes mellitus (T1DM) has increased globally over the last decades. Overweight and obesity affect individuals with T1DM and influence not only the autoimmune pathogenesis but also the long-term complications of T1DM. This study aimed to investigate the effect of excess body weight on the clinical presentation of T1DM. Methods: We conducted a retrospective, single-center cohort study at the largest pediatric endocrinology center in Hungary. Data were collected from children diagnosed with T1DM between 2014 and 2023. A total of 994 patients’ presentation parameters and anthropometric data were analyzed. Based on BMI Z-scores, patients were categorized into three groups (normal-weight, overweight, and obese). Metabolic parameters at diagnosis were compared between groups. Results: The combined ten-year prevalence of overweight and obesity was found to be 15.9%. Significant between-group differences were observed in pH (p=0.005), bicarbonate (HCO ₃ ^- ; p=0.018), partial carbon-dioxide (pCO ₂ ) pressure (p=0.018), and C-peptide levels (p< 0.001). Lower pH, pCO ₂ and HCO ₃ ^- levels were found among those who were overweight, and higher C-peptide levels in children with obesity. Diabetic ketoacidosis (DKA) and severe DKA were seen at a significantly higher rate among children with overweight and obesity (p=0.013; p< 0.001). Discussion: Children with overweight presented with more severe metabolic derangement at T1DM onset. Obese and overweight children have a higher risk of having DKA at presentation despite elevated C-peptide levels, which suggest a greater residual β-cell function. These findings support the hypothesis that other factors, such as chronic inflammation, may contribute to T1DM manifestation. Our findings highlight the impact of overweight and obesity on the clinical presentation of T1DM. In case of weight loss in obese and overweight children, more attention should be paid to the classical symptoms of T1DM.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents’ skills to deal with electronic health information sources. Objective: We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children’s outcomes. Methods: A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents’ electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children’s treatment, HbA_1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA_1c. Results: Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents’ average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children’s treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=−0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children’s HbA_1c (r=−0.143; P=.08), PedsQL Diab (r=−0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=−0.13; P=.12). Regression analysis revealed significant associations of the child’s HbA_1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=−0.66; P=.03; pump + sensor: β=−0.93; P=.007), and parents’ self-efficacy (PSESDM; β=−0.08; P=.001). Conclusions: Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents’ diabetes management attitude but not with the child’s glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.