Managing type 1 diabetes mellitus (T1DM) is challenging: blood glucose monitoring several times a day; total carbohydrate calculation to determine and adjust insulin requirements prior to mealtimes; insulin administration, either through multiple daily injections (MDI) or a pump; and diet modification. These necessary survival measures consume inordinate amounts of time and effort in the life of a person with diabetes. Ensuring that carbohydrate intake meets essential amounts also presents a major challenge. All of these requirements can have a serious impact on the quality of life (QoL) of school-age children. However, no recent studies have evaluated the impact of T1DM on the diet-related quality of life (D-QoL) of schoolchildren in the United Kingdom (UK). An additional deficiency is the limited availability of quantitative data, which might hinder the creation and acceptance of strategies for the development of improvements in this area. The overall aim of this research was therefore to employ quantitative measures as much as possible for an investigation of the impact of T1DM on the D-QoL of school-age children from their parents’ perspective, as well as to assess the children's intake of carbohydrate-rich foods. A newly designed two-part instrument was employed for these purposes: a D-QoL survey was adapted specifically for assessing the QoL of schoolchildren with T1DM, and a semi-quantitative food frequency questionnaire (SFFQ) was designed for evaluating the dietary intake of schoolchildren both with and without T1DM. In addition, thematic analysis was applied for the analysis of open-ended questions. A total of 181 schoolchildren (n = 42) with T1DM, and (n = 139) without T1DM aged 4 to 18 years old were included in this study. D-QoL scores were calculated based on averaged responses of each participant, with higher values indicating enhanced QoL. The results of the calculations seemed to indicate that most parents scored their children’s QoL in the medium category. Pearson’s correlation coefficient was applied for testing the relationships between a child’s age, duration of diabetes, HbA1c level, D-QoL scores, and total carbohydrate intake. No significant correlations were found between factors, with the exception of the age of schoolchildren with T1DM and their total carbohydrate intake, which was confirmed through a further linear regression: their total carbohydrate intake increased by 7.225 g for each year of their age. An independent sample t-test was used for comparing the differences in the average daily intake of total carbohydrates and sugar between school-age children with and without T1DM. The results showed that the average carbohydrate intake of schoolchildren with T1DM was 17.8% lower (-17.8%) than that of those without T1DM. The thematic analysis results revealed parents’ perceptions of a lack of T1DM related knowledge on the part of school staff. As well, the analysis demonstrated a dearth of carbohydrate information and portion sizes on school menus. Barriers to participation in social events such as parties, special occasions, and school activities involving food provided by others were another D-QoL-associated issue commonly cited by the families of children with T1DM. While broad generalization of the study results is limited by pandemic-related restrictions that affected sample size, the work reported here has broken new ground and serves to illuminate avenues for future research, which could benefit from input from children with T1DM, their parents, dietitians, healthcare professionals (HCPs), school staff, and catering providers. This research can guide future studies aimed at addressing T1DM-related issues in school settings, especially with regard to developing school menus that detail readily comprehensible carbohydrate content.
