As stated in the result section, the total DRQoL scores of the parent proxy report were significantly lower than the patients self-report (Table 2). In the assessment of DRQoL, it was expected that the scale and subscale scores of the patients and their parents would coincide (14, 15), which is not the case in this study. Of the quality-of-life domains, self-reports of diabetes symptoms and treatment barrier domains didn’t coincide with parent proxy reports while treatment adherence, worry and communication domains showed similar responses. The similarity of the responses may be due to the impact of the illness not only the patient but to the caregivers too.
It was also observed that patients scores in diabetes symptoms and treatment adherence domains were low, their scores in communication and worry domain were high. High communication score is similar and high worry score is on contrary to the findings in other studies (14, 16).
Regarding the effect of age on DRQoL, this study revealed the total scores of children (5–12 years old) (83.77), was higher than that of adolescents (13–18 years) (80.27). This discrepancy may be because most of the children were taken care of by their primary caregivers more than older children and adolescents. Also, adolescents tend to worry more than children which resulted in a lower DRQoL score.
It was also observed that age positively affects treatment adherence domain and negatively affects worry domain. These findings were on contrary to Emmanouilidou et al. who showed similar diabetes related quality of life except for treatment barriers (15). Abdul-Rasoul et al. and Mona et al. also showed poor DRQoL in younger age groups (4, 17). For a reason that young age children might be getting special care from parents in self-management of diabetes, they scored lower in the treatment adherence sub-domain but higher in the total score of DRQoL when compared to older children.
Similar to a study conducted by Gadallah et al. and Peyman et al., this study showed that health education about diabetes had significant positive associations with DRQoL of children and adolescents with diabetes (16, 18). This discrepancy may be because health education and promotion play a crucial role for respondents to understand their medical condition and take good care of themselves.
Patients who get their insulin administration by their primary caregiver have better DRQoL score than those who self-administer. This may be due to poor health education or having difficulty that the patients might not be administering insulin appropriately. No study was found on the connection between insulin administering personnel and quality of life in T1DM.
With regard to the relationship between DRQoL and metabolic control, we observed that higher mean FBS level is associated with lower diabetic symptom domain and total DRQoL score. This is similar finding observed in adolescents where increased FBS were associated with lower quality of life (4, 14, 19). The result of the current study could be explained by the fact that children and adolescents who had well-controlled blood glucose levels were associated with minimized episodes of common acute complications of T1DM.
The present study showed no effect of duration of illness on domains and total DRQoL score. This finding was similar to Mona et al. (17). Duration of T1DM was found to have negative effect of DRQoL in study by Abdul-Rasoul et al.(4).
Regarding the daily self-blood glucose tests, those who did self-blood glucose tests ≥ 1 times/day were found positively associated with treatment barrier domain. In alignment with this finding, those who did self-blood glucose tests ≥ 3 times/day scored better in all domains in two studies who revealed that higher number of daily self-blood glucose monitoring is associated with better QoL (17, 20).
In addition to the research data, a relationship was found between quality of life and educational status of patients, and mothers’ educational level. Similar findings were seen in two another studies (14, 18). This implies that patients with T1DM whose mothers have better educational status have a better ability to decide on child-care, and a better understanding of the disease, its complication, and treatment. Also, patients of fathers who had no occupation reported lower DRQoL scores compared to those who have a job. The possible justification might be due to fathers who have work are likely to generate income and can take care of their children, thus improving DRQoL.