Feasibility of Electronic Health Record Assessment of 6 Pediatric Type 1 Diabetes Self-management Habits and Their Association With Glycemic Outcomes

Abstract

IMPORTANCE A low-burden electronic health record (EHR) workflow has been devised to systematize the collection and validation of 6 key diabetes self-management habits: (1) checks glucose at least 4 times/day or uses continuous glucose monitor (CGM); (2) gives at least 3 rapidacting insulin boluses per day; (3) uses insulin pump; (4) delivers boluses before meals; (5) reviewed glucose data since last clinic visit, and (6) has changed insulin doses since the last clinic visit. OBJECTIVE To describe the performance of these habits and examine their association with hemoglobin A 1c (HbA 1c ) levels and time in range (TIR). DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included individuals with known type 1 diabetes who were seen in a US pediatric diabetes clinic in 2019. MAIN OUTCOMES AND MEASURESHabit performance, total habit score (sum of 6 habits per person), HbA 1c levels, and TIR. RESULTS Of 1344 patients, 1212 (609 [50.2%] males; 66 [5.4%] non-Hispanic Black; 1030 [85.0%] non-Hispanic White; mean [SD] age, 15.5 [4.5] years) were included, of whom 654 (54.0%) were using CGM and had a TIR. Only 105 patients (8.7%) performed all 6 habits. Habit performance was lower among older vs younger patients (age Ն18 years vs Յ12 years: 17 of 411 [4.1%] vs 57 of 330 [17.3%]; P < .001), Black vs White patients (3 [4.5%] vs 95 [9.2%]; P < .001), those with public vs private insurance (14 of 271 [5.2%] vs 91 of 941 [9.7%]; P < .001), and those with lower vs higher parental education levels (<college degree vs Նcollege degree: 35 of 443 [7.9%] vs 66 of 574 [11.5%];P < .001). After adjustment for demographic characteristics and disease duration, for every 1-unit increase in total habit score, we found a mean (SE) 0.6% (0.05) decrease in HbA 1c among all participants and a mean (SE) 2.86% (0.71) increase in TIR among those who used CGMs. Multiple regression models revealed that performing each habit was associated with a significantly lower HbA 1c level

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Errors in Abstract, Table 3, and Table 4

“…In the Original Investigation titled “Feasibility of Electronic Health Record Assessment of 6 Pediatric Type 1 Diabetes Self-management Habits and Their Association With Glycemic Outcomes,” 1 published October 28, 2021, there were errors in the Abstract, Table 3, and Table 4. In the Abstract and Table 4, the coefficient for the association of habit 1 with hemoglobin A 1c levels should have read −1.65%.…”

“…In Table 3, the number of male patients who performed habit 1a should have read 137. This article has been corrected …”