Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views

Aims To explore the difficulties parents encounter in trying to achieve clinically recommended blood glucose levels and how they could be better supported to optimize their child's glycaemic control. Methods In‐depth interviews were conducted with 54 parents of children with Type 1 diabetes (≤ 12 years). Data were analysed thematically. Results Parents described being reluctant and finding it difficult to keep their child's blood glucose levels consistently within clinically recommended ranges. As well as worrying about their child's ability to detect/report hypoglycaemia, parents highlighted a multitude of factors that had an impact on their child's blood glucose levels and over which they could exercise little control. These included: leaving their child with other caregivers who could not be trusted to detect hypoglycaemia; difficulties remotely monitoring and regulating their child's food consumption and activity; and physical and social changes accompanying childhood development. Most parents used two sets of blood glucose targets, with clinically recommended targets employed when their child was in their immediate care and higher targets when in the care of others. Parents described health professionals as lacking understanding of the difficulties they encountered keeping blood glucose within target ranges and needing more empathetic, tailored and realistic advice. Conclusion It is not parents' fear of hypoglycaemia in isolation that leads to decisions to raise their child's blood glucose but, rather, parental fear in conjunction with other factors and considerations. Hence, to improve diabetes management in children, these factors may need to be addressed; for instance, by training others in diabetes management and using new technologies. Changes to consultations are also recommended. What's new We drew upon parents' perspectives to understand why children with Type 1 diabetes have sub‐optimal glycaemic control. We found that it is not parents' fear of hypoglycaemia in isolation that leads them to elevate their child's blood glucose but, rather, parental fear in conjunction with other factors and considerations. Parents may use two sets of bloods glucose targets, with tighter targets employed when their child is under their direct care, and looser targets when in other people's care. Parents think health professionals have unrealistic expectations of what they can achieve with regards to their child's glycaemic control.