KNOWLEDGE, ATTITUDE AND PRACTICES AND ITS EFFECT ON TYPE - 1

DIABETES IN CHILDREN POPULATION

Chapter 1: Introduction

1.1Overview

Type 1 diabetes is a chronic illness in which the pancreas produces little or no insulin, the

hormone that regulates blood sugar. It usually develops during childhood or adolescence, but

it can happen at any age. Without adequate insulin, glucose accumulates in the bloodstream

rather than being absorbed by cells for energy, resulting in elevated blood sugar levels. With

a genetic background that is permissive, type 1 diabetes (T1D) is an autoimmune disorder

wherein various environmental factors, including food chemicals and viral infections, act as

autoimmune stimuli, ultimately leading to the partial or complete destruction of pancreatic

beta cells due to insulin deficiency (Rahmati et al. 2022).

Type 1 diabetes is generally treated with insulin for the rest of one's life. This can be

delivered via injections or an insulin pump. Monitoring blood sugar levels on a regular basis,

eating a balanced diet, and engaging in regular physical activity are all important aspects of

controlling type 1 diabetes.

While there is no cure for type 1 diabetes, continuing research is looking into potential

treatments such as beta cell transplantation and immunotherapy, both of which try to restore

insulin production or modify the immune system to prevent insulin-producing cells from

being destroyed. However, until a cure is discovered, controlling type 1 diabetes with insulin

therapy and lifestyle changes will remain the dominant method. Type 1 diabetes problems

might eventually impact various organs in the body. These organs are the heart, blood

vessels, nerves, eyes, and kidneys. Maintaining a stable blood sugar level can reduce the risk

of numerous problems. Diabetes complications can cause disability and even death. It is

noteworthy that in children with positive islet autoantibodies, continuous glucose monitoring
(CGM) can identify glucose problems prior to the diagnosis of type 1 diabetes; however, the

sample size for these prior investigations was limited (18–20) (Steck, et al. 2022).

Background of the topic

Type 1 diabetes has been recognised in India for many years, but its prevalence has risen in

recent decades due to a variety of variables including urbanisation, lifestyle changes, and

improved diagnostic procedures. The exact historical timeline of type 1 diabetes in India is

not well documented, however there has been an increase in awareness and understanding of

the disease over time.

Type 1 diabetes was formerly uncommon in India compared to type 2 diabetes, which is more

widespread and frequently connected with lifestyle factors such as nutrition and physical

inactivity. However, as the global incidence of type 1 diabetes rises, the number of cases in

India has also increased.

Type 1 diabetes poses specific issues in India due to variables such as restricted access to

healthcare facilities, financial restraints, and cultural norms. Furthermore, socioeconomic

issues and India's unique cultural landscape sometimes hamper type 1 diabetes therapy.

Efforts to combat type 1 diabetes in India include increasing awareness of the condition,

expanding access to healthcare services and diabetes management supplies, and conducting

research to better understand the genetic and environmental variables that contribute to its

prevalence.
Concerns for their child's health and safety cause parents of children with type 1 diabetes a

great deal of emotional and mental distress. The glycemic target of a glycated hemoglobin

level of less than 7% (as recommended by the American Diabetes Association) is attained by

less than 20% of children with type 1 diabetes (Breton et al. 2020). Their lives are upended

and emotionally taxing by the continual monitoring of their child's blood sugar levels, the

administration of insulin, and the handling of emergencies. Experts believe that juvenile onset

diabetes [type 1 diabetes] poses the greatest danger to small children (Chaudhary,2023). This

is because the body of small children is not fully developed and their immunity is also

developing. In order to keep their blood sugar levels consistent, children with type 1 diabetes

must follow rigid food and lifestyle restrictions. It can be challenging for kids who want to

join in on group activities or indulge in goodies like their friends when they have to watch

what they eat and drink, especially if it's sugary or contains carbs.

Overall, while the historical documentation of type 1 diabetes in India is limited, the growing

recognition and understanding of the condition highlights the importance of ongoing efforts

to improve diagnosis, treatment, and support for people living with the disease in the country

(O'Donnell, 2020).

1.2 Aims and Objectives

The study tries to find out certain objectives such as:

● To understand whether the patients are having enough knowledge regarding the type 1

diabetes its prevalence and prevention

● To find out lifestyle modification and change in diet patterns that can improve the

patient’s profile of type 1 diabetes

1.3 Problem Statement

Because type 1 diabetes typically manifests in young people, they must learn to manage the

condition from an early age. Kids and their families may feel overwhelmed by the demands

of diabetes management, which include constant blood sugar testing, insulin injections or

pump therapy, and food restrictions. Symptoms like irritation, lack of concentration, and

exhaustion brought on by blood sugar fluctuations can impact social interactions and

academic achievement. Due to the demands of diabetes control and health issues, children

may sometimes feel frustrated, anxious, or depressed. A person can die in a week, it is more

dangerous than type 2. Type 1 diabetes has now started taking a fatal form in the country.

The matter of concern is that children are its target (Chaudhary,2023). Severe hypoglycemia

(low blood sugar) and hyperglycemia (high blood sugar) episodes, if not treated quickly, can

occur in children with type 1 diabetes. Hyperglycemia causes symptoms like extreme thirst,

frequent urination, and ketoacidosis if not managed, whereas hypoglycemia causes dizziness,

confusion, and loss of consciousness if not addressed. The lifestyle restrictions are quite a big

problem for the kids and hence it needs to be addressed through the research.

1.4 Rationale

The rationale behind a study on type 1 diabetes among child are based on the following

points:

Worldwide, millions of children are living with type 1 diabetes, a chronic condition that has a

significant impact on their lives. In order to create successful measures for prevention,

management, and support, healthcare providers, lawmakers, and researchers must have a

thorough understanding of the incidence, prevalence, and effects of type 1 diabetes on the

health, wellbeing, and quality of life of children. Type 1 diabetes places a heavy financial and

emotional strain on healthcare providers, patients, and families. To better allocate resources

and improve outcomes while reducing the burden of type 1 diabetes in children, it is
necessary to study the economic costs, healthcare utilisation patterns, and resource needs

related to the disease. Hence, the research is undertaken to display the understanding of the

disease and the method of managing it.

Assessing the quality of treatment given to children with type 1 diabetes is crucial for

achieving the best possible results and making sure patients are satisfied. Child diabetes care

gaps, inequities, and improvement possibilities can be better understood through research on

healthcare delivery models, clinical standards, and care coordination systems. This scenario

sets the scene for conducting research on the topic. Negative effects on Quality of Life,

Social Exclusion, and Emotional Distress are Some of the Serious Psychosocial

Consequences of Type 1 Diabetes in Children. To better meet the specific requirements of

children with type 1 diabetes, it is important to learn more about the psychosocial aspects of

the disease, including family dynamics, coping strategies, and stigma.

Research on the effects of type 1 diabetes on children's health over the long term is essential

for elucidating the course of the disease and developing effective methods of clinical

management. Prevention efforts and health outcomes for children with type 1 diabetes can be

guided by research on risk factors, predictors, and therapies associated with diabetes-related

complications. These problems include cardiovascular disease, renal failure, and retinopathy.

Overall, research on paediatric type 1 diabetes is crucial for many reasons, including

expanding our understanding of the disease, bettering our ability to treat it, and improving the

quality of life for children who have it. Research on type 1 diabetes in children can help

improve outcomes for this vulnerable population by answering important research questions

and identifying priorities. This will allow the researchers to create evidence-based

programmes for prevention, care, and support.

1.5 Significance

One of the most prevalent chronic autoimmune disorders in children is type 1 diabetes (T1D).

The hallmark of the illness is the death of beta cells, which results in hyperglycemia and an

irreversible insulin-dependent state. Even if a number of research conducted in recent years

have provided important new information, the intricate pathophysiology of the illness is still

not fully understood. In an attempt to predict the onset and course of type 1 diabetes, recent

research has concentrated on a number of variables, including genetic susceptibility (HLA

and non-HLA genes), family history, and metabolic and environmental indicators. Beta cell

mass only represents the very late stages of the disease since it has already reached a crucial

threshold whenever a child develops symptoms (often a residual of 20–30% of normal

quantities). Specifically, there are two precisely recognized asymptomatic stages that precede

this ultimate stage. A variety of primary, secondary, and tertiary preventative techniques may

be suggested in light of the disease's protracted natural history and intricate etiology

(Primavera et al. 2020). All these data showcases the importance of the study.

The research significance is based on the following aspects such as:

Impact throughout Life: Type 1 diabetes typically manifests in young people and necessitates

ongoing care throughout their lives. Understanding the specific difficulties, treatment

requirements, and long-term consequences of type 1 diabetes in children requires research

that focuses on this population. Type 1 diabetes in children is becoming an increasingly

pressing issue in public health due to its rising frequency worldwide. In order to influence

healthcare planning, early detection initiatives, and preventative measures, studies on the

epidemiology, risk factors, and trends of type 1 diabetes in children are crucial. The effects of
type 1 diabetes on a child's physical and mental development, as well as their overall well-

being, can be devastating. In order to optimise results and minimise the impact of type 1

diabetes on children's well-being, research should be conducted to examine the physical,

psychological, and developmental impacts of the disease.

Consequences on Health: Cardiovascular disease, renal failure, and eye issues are among

diabetes-related complications that can develop in children with type 1 diabetes. The clinical

practice and long-term health outcomes of children with diabetes can be improved by

research on the risk factors, predictors, and management techniques for problems connected

to the disease.

Interventions and Methods: Insulin treatment, blood glucose monitoring, nutritional control,

and behavioural changes are all part of a holistic strategy for managing type 1 diabetes in

children. Diabetes care and treatment results can be improved by research into novel

treatment modalities, treatments based on technology, and personalised management

techniques designed specifically for children.

A child's emotional health, social functioning, and quality of life can all take a hit when their

type 1 diabetes isn't adequately managed. The creation of supportive treatments and resources

to address the holistic needs of children and families impacted by type 1 diabetes can be

informed by research addressing the psychosocial variables, such as family dynamics, coping

mechanisms, and stigma. Hence, the significance of the topic can be well defined.
Chapter 3: Methodology

3.1 Research Design

The research design pursued for this study is descriptive research for breaking down the

gathered information, different statistical tools and methods we are additionally used for

the reason to analyse and interpret the collected data.

Descriptive research

Descriptive research incorporates overviews and certainty findings enquiries of various

kinds. The significant reason for descriptive research is descriptions of the situation at it

exists at present. The techniques for research used in descriptive research are overview

strategies for all kinds, including correlation and comparative methods (Rezigalla, 2020).

3.2 Research Approach

The selection of research approach, whether inductive or deductive, depends on the nature of

the research topic and the complexity of the problems identified. Inductive process is a theory

building approach that starts with observation and data collection, formulating tentative

hypotheses, analysing the collected data and finally the development of new knowledge. As

opposed to the inductive approach, the deductive process starts with extensive study of

existing theories, followed by identification of research gaps and hypothesis development,

analysing the existing data using scientific methods and finally testing the existing studies

(Mulisa, 2022).

Deductive approach follows a general to a specific process and narrows down theoretical

knowledge after testing. However, an inductive approach follows a specific to a general

process and extends conceptual knowledge to develop a new theory. Deductive approach is a

theory testing process, which helps to test existing theories and conceptual models with the
help of empirical data obtained from primary research. On the other hand, an inductive

approach is a theory building process where the research starts with careful observation of

phenomena, followed by hypothesis development and confirmation.

3.3 Research philosophy

Philosophy deals with the nature of knowledge perceived by the researcher as to what is

acceptable knowledge. Positivism, interpretivism and realism are the key paradigms that

constitute the philosophical standpoint of epistemology. Positivism philosophy assumes that

material facts already exist in the universe and just need to be analysed using scientific

methods. Positivism supports academic studies that are formed on the basis of social realities

in a methodical system that replicates the process as used in accepted science (Tamminen, &

Poucher,2020). Interpretivism is an anti-positivist theory, and assumes that social research

cannot be simply tested using scientific research. On the other hand, realism assumes that

objects that exist in the universe can be felt by the human senses but are not dependent on

human acuity and perception. Pragmatism is a different research philosophy that argues that

research can be conducted using the positivist and the interpretivism approach.

Positivism supports objective based studies and extensive data testing using scientific

process. As opposed to positivism, the philosophy of interpretivism supports subjective based

studies where in-depth qualitative analysis can be carried out. To understand type 1 diabetes

and its impact on kids, a mere data testing using a positivist approach will help to elaborate

the women rights preservation technique. Hence, it is best to use the technique here.

3.4 Data collection

The two main sorts of data for presenting the study have been Primary and Secondary data
Primary data

Primary data is gathered as a survey through the questionnaire which comprises various

questions printed in definite order on a lot of structures, the respondents replied upon the

questions and understood the enquiries itself. The respondent needs to reply to the question

on their own and as per their perception.

Secondary data

Secondary data comprises data that as of now exist. Some places have been collected for

specific reasons in the study. The secondary data for the study was gathered from different

books, journals, websites, and brochures and so on.

3.5 Data Analysis

To analyse the collected data SPSS tool will be used. Within this tool, there will be an overall

calculation done of Anova, Frequency analysis, Cronbach alpha test for reliability tests. All

of these tests are carrying their own values and significance. These anova tests can help in the

relationship between an independent variable and one quantitative dependent variable.

Whereas, the descriptive statistics includes frequency analysis. In statistics, the term

"frequency" refers to how often something happens. Analysing measures of central tendency,

dispersion, percentiles, and occurrences (frequency) is an important part of frequency

analysis, a significant area of statistics. To collect the data there will be a usage of Google

Forms through which survey responses will be gathered and presented.

3.6 Sampling

A group of 59 parents of children who are having diabetes type 1 are going to be interviewed,

since the children are a very small age group and might not be able to answer all questions
properly. These responses will be collected through the Google forms. The sample inclusion

criteria:

 Speaking English

 Having a child with type 1 diabetes

 Must be Indian

The sample exclusion criteria:

 Not speaking English

 Having no child with type 1 diabetes

 Residing outside Indian

3.7 Ethics

· Maintaining confidentiality

· Consent by Informed Parties

· Preventing Harm to participants

· Ensuring Data Security

· Moral rectitude and accountability

3.8 Limitation

Time Constraints: Conducting a comprehensive analysis of 59 responses within a time limit

becomes the most threatening challenge to address.

Subject bias: The researcher might face a sample bias. Nevertheless, researchers shall strive

to reduce biases and strengthen the credibility of the study by thoroughly scrutinising and

cross-referencing the data, while preserving a coherent and logical framework in the written

analysis.
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