Parental quality of life and its influence on health-related quality of life in children with type 1 diabetes: a cross-sectional dyadic study in a multi-ethnic cohort

Children with type 1 diabetes mellitus (T1DM) rely heavily on caregivers for disease management, particularly in the early years following diagnosis. While child health-related quality of life (HrQOL) is widely recognised as a key outcome in diabetes care, the role of caregiver wellbeing, particularly within diverse sociocultural and economic contexts, has been insufficiently examined. This gap is especially relevant in multi-ethnic Asian settings, where family structures and caregiving expectations may diverge from Western norms. To evaluate the sociodemographic determinants of caregiver quality of life (QoL), and examine how these domains of caregiver wellbeing are associated with child-reported HrQOL in paediatric T1DM. We conducted a cross-sectional study involving 72 parent–child dyads recruited from a tertiary paediatric endocrinology clinic in Singapore. Children (< 18 years) and their primary caregivers independently completed validated QoL instruments (KIDSCREEN-27 and WHOQOL-BREF, respectively). Sociodemographic variables were collected, and multivariable linear regression was performed to evaluate associations between caregiver QoL, socioeconomic indicators, and child-reported HrQOL, adjusting for relevant covariates. Caregiver QoL was significantly influenced by household income, education, spousal support, and family configuration. Financial hardship, absence of spousal or maternal support, and lower educational attainment were associated with poorer caregiver QoL across multiple domains (p < 0.050). In turn, higher caregiver psychological wellbeing, social relationships, and personal beliefs were positively associated with child-reported QoL across physical, emotional, autonomy-related, and school-related domains (p < 0.010). Caregiver wellbeing is a critical determinant of child HrQOL in paediatric T1DM. These findings highlight the importance of incorporating caregiver-focused psychosocial and structural support into family-centred diabetes care models. Proactively addressing caregiver needs, particularly in families experiencing socioeconomic or relational vulnerability, may offer a meaningful pathway to improve outcomes for both children and their caregivers.