Knowledge, Practice and Associated Factors to Ward Hypoglycemia Prevention Among Caregivers of Diabetic Children: Cross Sectional Study Design

doi:10.21203/rs.3.rs-5007624/v1

Background

Hypoglycemia is an acute medical condition that occurs when blood sugar falls below 70 mg/dl. It is a common and potentially life-threatening complication in children with diabetes. Caregivers play a crucial role in managing and caring for their child's diabetes. This study aimed to assess hypoglycemia prevention knowledge, practices, and associated factors among caregivers of diabetic children during follow-up at the Ayder Comprehensive Specialized Hospital Pediatric Endocrinology Clinic in 2024.

Methods

An institutionally based cross-sectional study was carried out between September 2023 and April 2024. A structured questionnaire was used to gather data, and statistical tools for social sciences software, version 25.0, were used for analysis. The dependent and independent variables were tested for relationships via bivariate and multivariate analyses.

Results

Of the 162 enrolled caregivers of diabetic children, 50.6% were mothers, and 81.5% were urban dwellers. In this study, thirty (18.5%) of the caregivers had good knowledge, and sixty-eight (42%) of them had good practices for preventing hypoglycemia. Formal training and education programs were significantly associated with good knowledge (AOR = 17.9, CI: 4.6–70.2). Good hypoglycemia prevention knowledge was significantly associated with hypoglycemia prevention practices (AOR = 0.32; CI: 0.13–0.76).

Conclusion

Knowledge and practices related to hypoglycemia prevention among caregivers of diabetic children were low. Providing formal training and education to caregivers and counseling regarding hypoglycemia during their visit are essential for improving their knowledge and practice in hypoglycemia prevention.

Diabetes Mellitus

Hypoglycemia

Prevention

Practice

Knowledge

Caregivers

Diabetes mellitus (DM) is a common chronic metabolic disease caused by changes in insulin sensitivity or secretion. It is characterized by hyperglycemia and impaired metabolism of carbohydrates, proteins, and fats (1, 2). In the United States, type 1 diabetes mellitus (T1DM) affects 190 out of every 100,000 school-aged children (2). The estimated prevalence of diabetes in Ethiopia is between 2% and 6.5% (3).

Acute hypoglycemia is a medical emergency that occurs when blood sugar levels drop below the recommended level of 70 mg/dl(4, 5). Individuals who use diabetes drugs have a greater chance of developing low blood sugar, which can result from high insulin doses, missing meals, or lower insulin requirements during activity(4, 6). It is prevalent, accounting for approximately 70.8% of T1 DM cases (7). It is linked to cognitive dysfunction, anomalies in brain structure, and the possibility of lasting brain damage and death, especially in young children with type 1 diabetes (8, 9).

Hypoglycemia prevention is a critical component of diabetes management. Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are essential tools for assessing therapy and detecting incipient hypoglycemia (4, 10). Patients and their caregivers should be aware of the circumstances that can lead to hypoglycemia, including skipping meals, insulin overdosing, and engaging in vigorous exercise(8, 11).

For children with diabetes, managing their blood sugar level can be particularly challenging; they rely on their caregivers to monitor their glucose levels and administer insulin or other medications as needed. Therefore, it is crucial for caregivers to have adequate knowledge and practice in preventing hypoglycemia in these children.(11, 12)

A thorough understanding of diabetes care, including routine blood sugar testing, appropriate insulin dosage adjustments, and identification of warning signs and symptoms of low blood sugar, is necessary for the prevention of hypoglycemia (4, 10). Caregivers need to be educated on the risk factors that cause hypoglycemia and how to prevent and act quickly and effectively when hypoglycemia occurs(12, 13).

Several studies have shown that knowledge and practices related to hypoglycemia prevention are associated with good glycemic control(11, 14, 15). Despite this fact, recent studies conducted in different countries indicate that many individuals lack the necessary knowledge and practice regarding hypoglycemia prevention, which could have an adverse effect on their children's overall diabetes control and associated complications(14–17).

This study aims to assess knowledge, practices and associated factors related to hypoglycemia prevention among caregivers of diabetic children. This information will be helpful in designing subsequent interventions to improve diabetic care in general for children with T1DM.

Study area and study period

The study was carried out at the Endocrinology Follow-up of ACSH, Mekelle Tigray, Ethiopia, from September 2023 to April 2024. There were a total of 199 diabetic patients followed at the Endocrinology Clinic of ACSH, 36 of whom were newly diagnosed with T1DM, and 162 were included in the study.

Study design

An institution-based cross-sectional study design with prospective data collection was used.

Sample size and sampling technique

To calculate the sample size, we used a single population proportion formula with the assumption of a 95% confidence level, a 5% marginal error, a 10% nonresponse rate and a 25.5% proportion of knowledge from a study conducted in South Gondar(15). Since the source population consisted of fewer than 10,000 respondents, the sample size was adjusted via a correction formula. This revealed a final sample size of 147.

All the caregivers who provided primary care to children with diabetes and who provided consent were included in the study. Those who were not given primary care for the child and who were newly diagnosed were not included in the study.

Data collection method and analysis

A questionnaire was used to gather information about people's knowledge and usage of hypoglycemia prevention after questionnaires were developed from different articles. There were four sections to the questionnaire. It comprises demographic profiles, as well as psychological state and knowledge and practice questionnaires about preventing hypoglycemia. Their academic standing was divided into groups according to the grades they received. Data were collected weekly on the basis of follow-up.

Data analysis was performed via SPSS version 25. A P value of 0.05 was considered statistically significant. Bivariate and multivariate logistic regression were used to assess the effect of each independent variable on the dependent variable. The odds ratio and 95% confidence interval were computed to assess the strength of the associations and their statistical significance.

Good hypoglycemia prevention knowledge is defined as caregivers providing answers equal to or above the mean score of knowledge questions. Good hypoglycemia prevention practice is defined as a caregiver answering with a score equal to or above the mean score of the practice questions(15).

Sociodemographic characteristics

A total of 162 caregivers of diabetic children participated in this study. The mean age of the caregivers included in the study was 36.48 years, with an S.D. of ± 10.97 years, and the mean age of the diabetic children was 10.83 years, with an S.D. of ± 4.77. Ninety-six (59.3%) of the children were female. Eighty-two (50.6%) of the participants were mothers, and thirty-nine (24.1%) were fathers. A total of 150 (92.6%) respondents were orthodox Christians, and 23 (14.2%) of the respondents did not have formal education. Sixty-two (38.3%) of the mothers were housewives, and 112 (69.1%) of the caregivers were married. (Table 1)

Table 1

Sociodemographic characteristics of caregivers and their children following at the Endocrinology Follow-up Clinic at ACSH, 2024 (N = 162)
	(N = 162)	(%)	Characteristics	(N = 162)	(%)
Sex of child			Educational Status
Female	96 (59.3)	59.3	Primary	27	16.7
Male	66 (	40.7	Secondary	64	39.5
Total	162	100	College	48	29.6
Age of child			Unable to read or write	23	14.2
≤ 5year	27	16.7	Total	162	100
6–10	51	31.5	Residency
> 10	84	51.9	Urban	132	81.5
Total	162	100	Rural	30	18.5
Age of caregivers			Total	162	100
18–30	57	35.2	Relation to child
31–45	82	50.6	Mother	82	50.6
> 45	23	14.2	Father	39	24.1
Total	162	100	Guardians	41	25.3
Duration of diseases			Total	162	100
≤ 1 year	31	19.1	Occupation
1-5years	82	50.6	House wife	62	38.3
6-10years	38	23.5	Farmer	15	9.3
≥ 10 years	11	6.8	Merchant	25	15.4
Total	162	100	Employed	32	19.8
Religion			Other	28	17.3
Orthodox	150	92.6	Total	162	100
Muslim	6	3.7	Number of children who had DM
Protestant	5	3.1	1	154	95.1
Catholic	1	0.6	≥ 2	8	4.9
Total	162	100	Total	162	100
Marital status			Income
Married	112	69.1	Low < 5000ETB	93	57.4
Single	34	21	Middle 5000–10000	68	42
Divorced	14	8.6	High > 10000	1	0.6
Widowed	2	1.2	Total	162	100
Total	162	100

Knowledge of caregivers regarding hypoglycemia

Among all the knowledge questions, 30 (18.5%) had good knowledge of hypoglycemia prevention; however, 58 (35.8%) had poor knowledge of identifying symptoms of hypoglycemia. With respect to the blood glucose level, 67 (41.4%) of the caregivers knew that it was less than 70 mg/dl. The majority (108, 66.7%) of the participants did not know that exercise and too much insulin aggravated hypoglycemia, one hundred seven (66.1%) of the caregivers knew that skipping meals led to hypoglycemia, and 39 (24.1%) of the respondents were not sure of the potential causes. (Table 2)

Table 2

Knowledge of hypoglycemia among caregivers at the Endocrinology Follow-up Clinic at ACSH, 2024 (N = 162)
Variable	Good knowledge n (%)	Poor knowledge n (%)
Hypoglycemia	43(26.5%)	119(73.4%)
Level of glucose to say hypoglycemia < 70	67(41.4%)	95(58.4%)
Symptoms of hypoglycemia	104(64.2%)	58(35.8%)
Effect of skipping meal on hypoglycemia	107(66.1%)	55(33.9%)
Effect of excessive exercise and insulin over dose	54(33.3%)	108(66.7%)
Meal adjustment with insulin as hypoglycemia prevention method	74(45.7%)	88(54.3%)

Practice of caregivers regarding hypoglycemia prevention

Among the total respondents, sixty-eight (42%) study subjects had good practices in hypoglycemia prevention. A total of 154 (94.4%) of the participants used a combination of methods (NPH and RI), 137 (84.6%) of the participants used a glucometer at home, and 64 (39.5%) of the caregivers ensured that their diabetic child was taking regular meals with snacks. 70 (43.2%) monitor the blood glucose of their child occasionally. A total of 106 (65.4%) of the children experienced hypoglycemia, and 82 (50.6%) delayed insulin administration until it was corrected.

A total of 158 (97.5%) gave something sugary immediately if their child experienced hypoglycemia. Approximately 74 (45.7%) caregivers preferred meal adjustment with insulin to prevent hypoglycemia. (Table 3)

Table 3

Practice of caregivers regarding hypoglycemia prevention at the Endocrinology Follow-up Clinic at ACSH, 2024 (N = 162)
Variables	Good practice (%)	Poor practice n (%)
Diet follow up	65(40.1%)	97(59.9%)
Monitor blood glucose level	48(29.6%)	114(70.4%)
Hypoglycemia treatment	65(40.1%)	97(59.9%)
Taking medication appropriately	72(44.4%)	90(55.6%)
Hypoglycemia episode	36(33.9%)	70(66.1%)
Insulin injection in the presence of hypoglycemia	60(37.1%)	102(62.9%)
Adjustment of medication	82(50.6%)	80(49.4%)
Type of insulin	76(46.9%)	86(53.1%)
Owns glucometer at home	49(35.7%)	88(64.2%)

Associations of selected demographic variables with hypoglycemia prevention knowledge and practices

Bivariate logistic regression analysis revealed that the age of the caregiver (P = 0.025), place of residency (p = 0.024), occupation (p = 0.044), relationship with a diabetic child (p = 0.010) and training and educational programs (P = 0.000) were factors associated with knowledge of hypoglycemia prevention. However, only the formal training and educational program and the relationship with diabetic children were significantly associated (p = 0.00; AOR: 17.891 95% CI 4.559–70.213) and (p = 0.012; AOR: 0.093 95% CI 0.016–0.553), respectively, according to multivariate regression. (Table 4)

Bivariate logistic regression analysis revealed that the age of the caregiver, residency, marital status, financial status, level of education, relationship with a diabetic child, insulin type, level of stress, hypoglycemia episodes, owning a glucometer, training and education and level of knowledge were factors associated with hypoglycemia prevention practices. However, only the level of knowledge, number of hypoglycemia episodes, use of a glucometer, formal training and education level and age of the caregivers were significantly associated (p = 0.01; AOR: 0.32 95% CI (0.13–0.76), p = 0.014; AOR: 2.51 (1.20–5.22), P = 0.001; AOR: 8.05 95% CI 2.4–26.9), P = 0.033; AOR: 2.31 95% CI 1.07–4.9; and P = 0.02; AOR: 0.19 95% CI 0.36–0.94, respectively, according to multivariate regression. (Table 5)

Table 4

Association of selected demographic variables with hypoglycemia knowledge in ACSH 2024 (n = 162) A **P value < 0.05 was considered scientifically significant.**
Variable	Good n (%)	Poor n (%)	P value	COR(95% CI)	P value	AOR(95% CI)
Age of caregiver			0.025		0.742
18–30	7(12.2%)	50(87.7%)	0.009	0.22[0.07–0.69]		0.45[0.6–3.4]
31–45	14(17.1%)	68(82.9%)	0.028	0.32[0.12–0.89]		0.66[0.13–3.3]
> 45	9(39.1%)	14(60.9%)		1		1
Educational level			0.00		0.8
Primary	9(33.3%)	18(66.7%)	0.29	0.55[0.17–1.71]		1.07[0.65–1.76]
Secondary	7(10.9%)	57(89.1%)	0.001	0.13[0.04–0.42]		0.9[0.0`-1.5]
College	3(6.25%)	45(93.7%)	0.000	0.07[0.017-0.3]		0.1[0.001–1.001]
No formal education	11(47.8%)	12(52.2%)		1		1
Residency			0.024		0.658
Urban	20(66.7%)	10(33.3%)		1		1
Rural	20(15.5%)	112(84%)		2.8[1.143–6.859]		1.48[0.29–7.4]
Marital status			0.456
Single	6(17.6%)	28(82.3%)
Married	22(19.6%)	90(80.4%)
Divorce	6(33.3%)	12(66.7%)
Occupation			0.044		0.370
House wife	49(79.03)	13(20.9%)		3.45[0.72–16.46]	0.062	6.06[0.92–40.2]
Farmer	8(53.3%))	7(46.7%)	0.007	11.38[1.96–66.11]		3.01[0.22–41.8]
Merchant	21(84%)	4(16%)		2.48[0.41–14.9]		3.9[0.37-41]
Employed	28(87.5%)	4(12.5%)		1.86[0.31-11.0]		13.2[0.8–223]
Other	26(92.8%)	2((7.1%)		1		1
Relation			0.010		0.012
Mother	8(9.7%)	74(90.2%)	0.071	0.38[0.14–1.09]	0.009	0.09[0.02–0.55]⁕
Father	13(33.3%)	26(66.7%)		1.78[0.66–4.81]		1.72[0.29–10.04]
Guardians	9(21.9%)	32(88.1%)		1		1
Duration of disease			0.927
≤ 1 year	6(19.4%)	25(80.6%)		2.4[0.26–22.6]
1-5years	14(17.1%)	68(82.9%)		2.1[0.24–17.4]
6-10years	9(23.7%)	29(76.3%)		3.1[0.35–27.7]
≥ 10 years	1(9.9%)	10(90.9%)		1
Formal training or education you received			0.000		0.000
yes	71(61.2%)	45(38.8%)		19.3[5.94–67.16]		17.9[4.56–70.2]⁕
no	26(56.5%)	20(43.5%)		1		1
Level of stress			1.021
Mild	4(3%)
Moderate	17(56.7%)	50(37.8%)
Sever	13(43%)	78(59.1%)
Income			0.68
Middle	12(40%)	56(42.4%)
low	17(56.7%	76(57.6%)

Table 5

Association of selected demographic variables with hypoglycemia practice in ACSH, 2024 (n = 162) A **P value < 0.05 was considered scientifically significant.**
Variable	Good	Poor		P value	COR(95% CI)	P value	AOR(95% CI)
Age of caregiver			0.037			0.02
18–30	27(47.4%)	30(52.6%)			0.58[0.216–1.55]		0.91[.29-2.79]
31–45	27(32.9%)	55(67.1%)			0.32[0.121–0.821]		0.31[0.11–0.93]⁕
> 45	14(60.9%)	9(39.1%)			1		1
Educational level				0.134		0.59
Primary	13(48.1%)	14(51.9%)			1.40[0.458–4.28]		1.424[0.35–5.78]
Secondary	28(43.8%)	36(56.2%)			1.671[0.64–4.37]		1.58[0.43–5.85]
College	14(29.2%)	34(70.8%)			3.16[1.124–8.87]		5.36[1.02–28.06]
No formal education	13(56.5%)	10(43.5%)			1		1
Residency				0.030		0.37
Urban	50(37.9%)	82(62.1%)			1		1
Rural	18(60%)	12(40%)			0.407[0.18–0.91]	0.435	0.65[0.25–1.69]
Marital status				0.85
Single	20(22.5%)	69(77.5%)
Married	43(75.4%)	14(24.6%)
Divorce	3(21.4%)	11(78.6%)
Occupation				0.885
House wife	25(40.3%)	37(59.7%)			0.68[0.28–1.66]
Farmer	10(66.7%)	5(33.3%)			2[0.54–7.4]
Merchant	7(28%)	18(72%)			0.39[0.12–1.2]
Employed	12(37.5)	20(62.5%)			0.6[0.2–1.7]
Other	14(50%)	14(50%)			1
Relation				0.018		0.23
Mother	28(34.1%)	54(65.9%)			0.33[0.15–0.72]		1.48[0.95–2.3]
Father	15(38.5%)	24(61.5%)			0.40[0.16–0.98]		0.49[0.18–1.4
Other	25(60.9%)	16(39.1)			1		1
Duration of disease				0.937
≤ 1 year	16(51.6%)	15(48.4%)			1.3[0.32–5.1]
1-5years	29(35.4%	53(64.6%)			0.66[0.18–2.3]
6-10years	18(47%)	20(52.6%)			1.1[0.28–4.2]
≥ 10 years	5(45.5%)	6(54.5%)			1
Training or Education you received				0.001		0.033
Yes	88(59.1%)	61(40.9%)			0.35[0.182–0.67]		2.31[1.07–4.9]⁕
No	7(53.8%)	6(46.2%)			1		1
Knowledge				0.003		0.01
Good	20(66.7%)	10(33.7%)			3.500[1.50–8.09]		0.32[0.13–0.76]⁕
Poor	48(36.4%)	84(63.6%)			1		1
Stress level				0.072
Hypoglycemia episode	36(33.9%)	70(66.1%)		0.005	0.386[0.198–0.75]	0.014	2.51[1.2–5.22]⁕
Income				0.093	1.715[0.92–3.22]	0.38	1.49[0.7–3.14]
Type of insulin (BID)	67(44%)	86(56%)		0.088	2.49[0.87–7.15]	0.13	2.4[0.78–7.4]
Frequency				0.999
Owning Glucometer	49(35.7%)	88(64.2%)		0.001	5.687[2.1–15.2]	0.001	8.05[2.4–26.9]⁕

With the current study, we aimed to determine the knowledge and practice level of caregivers of children with type I diabetes mellitus and the factors associated with prevention of hypoglycemia at ACSH in Mekelle wards. This is particularly important for understanding the situation in the local context and addressing the existing gaps with respect to the knowledge and practices of hypoglycemia prevention, with the ultimate goal of improving the hypoglycemia prevention practices given to this population and, hence, reducing the associated complications and improving the quality of care of patients.

This study revealed low levels of knowledge of and practices related to hypoglycemia prevention among caregivers of diabetic children and identified the factors associated with the dependent variable.

In our study, 30 (18.1%) participants had good knowledge of hypoglycemia prevention. This percentage is lower than that reported in a study performed at the medical OPD in Smch, India, where 76% of the participants had good knowledge(18) and 47.3% of the study participants had good knowledge of hypoglycemia in Ghana, 2021(19). According to Das et al., 52% of participants had good knowledge about hypoglycemia(17). Our result is slightly higher than the 8% rate of good knowledge reported by the National Guard Primary Health Care Center, Jeddah, Saudi Arabia, in 2017 (14). This variation may be due to the educational status, emotional stability, peace, and stability of the country. Twenty (66.7%) urban dwellers were knowledgeable about hypoglycemia prevention. This percentage is relatively high compared with that reported in a study conducted in South Gondar, Northwest Ethiopia, in which 29.6% had good knowledge and 47.9% from Cecyli et al.(15, 18). This difference could be due to time variation, differences in educational status, or sample size.

In this study, sixty-eight (42%) of the participants reported good practices for hypoglycemia prevention, which is higher than the percentage reported in studies conducted in South Gondar, Northwest China, and Ethiopia, in which 89 (21.4%) participants reported good practices(15). This variation may be due to differences in the educational status of the participants, study population and area, sample size and time. Our findings are lower than those of the studies conducted at Gondar Teaching Hospital, Ethiopia 2019 (93.1%) and in the central zone, Tigray, Ethiopia 2018 (63.2%)(20, 21). This difference might be due to the different emotional stabilities of the respondents, the peace and stability of the study area and the time variation.

In this study, 67 (41.4%) of the participants knew that hypoglycemia occurred when the level was less than 70 mg/dl. This percentage is lower than that reported in studies conducted in the National Guard Primary Health Care Center, Jeddah, Saudi Arabia, in 2017, which was 50.7%, and in Gondar University Teaching Hospital 2019 (82.2%)(14, 20). This discrepancy might be due to sociodemographic differences, educational status, diabetic knowledge and training availability, and the accessibility of health facilities.

In a study performed at El-Mabara Hospital, Egypt, in 2019, 44.28% of the caregivers had good knowledge about the cause of hypoglycemia (13), whereas in our study, 64.2% of the participants had good knowledge about the cause of hypoglycemia. This variation might be due to time differences, sociodemographic differences, sample sizes, study populations and means of data collection. In our study, 66.1% of the participants reported skipping meals as a cause of hypoglycemia, whereas 93.9% of the participants reported delaying meals as a cause (22). This discrepancy may be due to sociodemographic characteristics, the accessibility of health facilities and educational programs, the emotional stability of the participants and the sample size.

In our study of all the caregivers who participated, one hundred thirty-two (84.6%) reported that they had glucometers at home, and 33.3% of them had good practices for preventing hypoglycemia in our study, which was lower than those reported in studies conducted in Guwahati, Assam 2022, and in the central zone, Tigray, 2018, and (16, 21). This variation may be due to different diabetes education programs.

One hundred forty-three (88.3%) of the participants were able to identify hypoglycemia symptoms, which is slightly lower than that reported in the study performed at St. Pual’s Hospital millennium medical college, AddisAbeba, Ethiopia; 2019 (94.3%) of the participants could identify symptoms of hypoglycemia (22)and was higher than that reported from Khartoum, Sudan, 2013 (52%)(23). This result might be due to sociodemographic differences, health service differences, educational status and differences in the study population.

Twenty-five (40.3%) of the housewife participants had good practices for preventing hypoglycemia in this study. This percentage was higher than that reported in a study performed in the central zone of a public hospital in Tigray, Ethiopia, 2018, which was 14%(21). This difference could be because of time differences, the use of regular follow-up clinics, differences in diabetes education programs, the accessibility of education and the sample size.

In our study, knowledge of hypoglycemia prevention, experiencing hypoglycemia episodes and using a glucometer were significantly associated with hypoglycemia prevention practices, which was similar to the findings of various studies (Das et al., Sakyi et al. 2022, Almigbal. Th et al., and Wako et al. 2017 (17, 19, 24, 25). In this study, good hypoglycemia prevention knowledge and a glucometer were significantly associated with good hypoglycemia prevention practices, which is similar to the findings of other studies performed at Gondar Teaching Hospital, Ethiopia, and Central China, Zone, and Tigray, Ethiopia(20, 21). Our results revealed that formal training and educational programs were significantly associated with knowledge of hypoglycemia prevention and hypoglycemia prevention practices, which is similar to the findings of Nordfeldt et al. and Bhutani et al. (2015) and a study performed in Central China, Zone, Tigray, Ethiopia (9, 10, 21).

Individuals with high education levels usually have good knowledge scores about diabetes, diabetes risk factors and diabetes management. Education level did not affect knowledge of hypoglycemia symptoms in this study. This result was similar to that of Sakiy et al., Muche and Mekonen et al.2019 and Madani et al. 2013, (19, 20, 23). However, in a study conducted in Guwahati, Assam’s 2022 educational status affected hypoglycemia prevention knowledge(16).

In the present study, there was no association between employment, income, religion, residency or marital status and knowledge and practices related to hypoglycemia prevention. These findings are supported by studies by Sonam and Jayalakshmi et al. 2022, Das et al. 2022 and Sakiy et al. 2022 (16, 17, 19).

In conclusion, knowledge of and practices related to hypoglycemia prevention among caregivers of diabetic children are limited, as revealed by this study. Providing formal health education to caregivers and being mothers of diabetic children was significantly associated with knowledge of hypoglycemia prevention. Level of knowledge about hypoglycemia prevention and episodes of hypoglycemia. Owning a glucometer, formal training and education, and the age of the caregiver were significantly associated with the hypoglycemia prevention practices of the caregiver.

In conclusion, knowledge of and practices related to hypoglycemia prevention among caregivers of diabetic children are limited, as revealed by this study. Providing formal health education to caregivers and being mothers of diabetic children was significantly associated with knowledge of hypoglycemia prevention.

Level of knowledge about hypoglycemia prevention and episodes of hypoglycemia. Owning a glucometer, formal training and education, and the age of the caregiver were significantly associated with the hypoglycemia prevention practices of the caregiver.

CGM

Continuous glucose monitoring

SMBS

Self-Monitoring of Blood Sugars

T1DM

Type 1 diabetes mellitus

DM

Diabetic Mellitus

Ethical considerations: Permission was acquired from the hospital authorities, and ethical clearance was obtained from the Institutional Review Board of Mekelle University College of Health Science (RE of MU-IRB 2166/2024). Prior to their recruitment into the trial, all study participants provided written informed consent.

Clinical trial number: Not applicable

Consent of publish declaration: Not applicable

Authors’ contributions: AL was responsible for the idea's conception, method design, tool development, supervision of data collection, data analysis, and manuscript drafting. In addition to reviewing the study protocol and tool and the draft text, AG and MK provided support for the study design. The final draft of the manuscript was reviewed and approved by AL, AG, and MK.

Competing interests: The authors declare that they do not have any competing interests related to the work.

Funding: The study is funded by ACSH, Postgraduate and Research Coordinating Office.

Acknowledgment: The author would like to acknowledge the caregiver who gave us their consent and responded to our questionnaire.

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No competing interests reported.

Knowledge, Practice and Associated Factors to Ward Hypoglycemia Prevention Among Caregivers of Diabetic Children: Cross Sectional Study Design

Status:

Version 1

Abstract

Introduction

Methods and materials

Results

Sociodemographic characteristics

Knowledge of caregivers regarding hypoglycemia

Practice of caregivers regarding hypoglycemia prevention

Associations of selected demographic variables with hypoglycemia prevention knowledge and practices

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1