P-201: The importance of analyzing social risk, and the role of parent fear-based avoidance on glycemic outcomes
S Nozime, S R Patton, A Monzon, J S PierceAbstract
Introduction
Management of type 1 diabetes (T1D) in very young children (YC-T1D; <6yrs) is entirely caregiver-dependent, making parent factors critical to outcomes. Sociodemographic risk is associated with higher glycemic levels, yet mechanisms remain unclear. Fear of hypoglycemia (FoH) in parents of YC-T1D is common, and the presence of worry and avoidance behaviors may shape how social risk factors (SRF) translates to child HbA1c, representing a modifiable intervention target.
Objectives
To examine if parent FoH moderates the association between SRF and HbA1c in YC-T1D.
Methods
Data is from a randomized clinical trial of 143 parents of YC-T1D. Given no intervention effects, we combined groups and included randomization status as a covariate. We created a cumulative baseline SRF index using dichotomized indicators (race/ethnicity, parent education, income, insurance). The Hypoglycemia Fear Survey-Parent (HFS-P: Total, Behavior, Worry) and child HbA1c (mailed dried blood spot kits) were assessed at 0, 6, and 12m. PROCESS in SPSS V27 moderation models estimated conditional effects of SRF on 12m-HbA1c across low, average, and high 6m-FoH levels.
Results
HFS-P Behavior significantly moderated the association between SRF and HbA1c (b=0.04, p=0.03) and explained an additional 3.3% of variance. HFS-P Total and Worry were not significant moderators. Simple slopes indicated that SRF was not associated with HbA1c at low HFS-P Behavior levels (i.e., low avoidance behaviors) but was significantly associated at average (b=0.18, p=0.01) and high levels (b=0.35, p<0.001).
Conclusions
Parent FoH-related avoidance behaviors amplify negative impact of SRF on glycemic outcomes in YC-T1D. Higher SRF may drive baseline parental stress, and avoidant coping mechanisms may lead to maladaptive caregiving patterns that maintain elevated glucose. Interventions targeting FoH in high-risk families provide a practical strategy to buffer SRFs and improve child glycemic outcomes.