Twelve‐month psychosocial outcomes of continuous glucose monitoring with behavioural support in parents of young children with type 1 diabetes

Abstract

Aim: Managing type 1 diabetes in young children can cause significant stress for parents. Continuous glucose monitoring (CGM) may reduce parental burden. The Strategies to Enhance CGM Use in Early Childhood (SENCE) trial randomized parents of children (ages 2 to <8 years) with type 1 diabetes to CGM with family behavioural intervention (CGM + FBI), CGM alone (Standard-CGM) or blood glucose monitoring for 26 weeks before receiving CGM + FBI (BGM-Crossover). This report assesses changes in psychosocial outcomes for all groups over 52 weeks. Methods: CGM + FBI (n = 45), Standard-CGM (n = 42) and BGM-Crossover (n = 44) participants completed psychosocial assessments at baseline, 26 weeks and 52 weeks. Repeated measures linear regression models evaluated change within and between treatment groups. Results:The BGM-Crossover group reported improved diabetes burden (Δ −6.9, 95% CI [−11.3, −2.6], p = 0.003), fear of hypoglycaemia (Δ −6.4, CI [−10.1, −2.6], p = 0.002) and technology satisfaction (Δ 7.3, CI [2.4, 12.2], p = 0.005) from 26 to 52 weeks, similar to published findings in the CGM + FBI group over the first 26 weeks. The Standard-CGM group reported increased technology satisfaction (Δ 7.3, CI [0.6,14.0], p = 0.027) from baseline to 52 weeks. The CGM + FBI group reported less diabetes burden and fear of hypoglycaemia from baseline to 52 weeks, but changes were not statistically significant. Scores from 26 to 52 weeks did not deteriorate.Conclusions: Parents demonstrated psychosocial benefits following FBI that appeared to maintain without additional intervention. CGM-focused education with behavioural support likely helps parents of young children with type 1 diabetes reduce burden and worry in the short-and long-term. K E Y W O R D Sburden, CGM, fear of hypoglycaemia, randomized clinical trial, type 1 diabetes, young children

Recommendations for recognizing, risk stratifying, treating, and managing children and adolescents with hypoglycemia

“…The opinions of healthcare workers established using Delphi methodology indicated a need for specialized and expert staff (specialized nurses, educators) to train PWD on technologies applied to diabetes ( 91 ). Behavioral interventions for family members have shown persistent psychosocial benefits.…”

“…Behavioral interventions for family members have shown persistent psychosocial benefits. CGM-focused education with behavioral support probably helps parents of young children with T1D reduce short- and long-term burden and worries ( 91 ). Furthermore, a telehealth approach may be helpful in the treatment of FoH ( 92 ).…”

Integrating psychosocial and behavioral interventions into type 1 diabetes care

“…The study faced recruitment challenges and high attrition, and had only minimal impact on parenting behavior with no significant changes in glycemia, child behavior or QoL. Another RCT ( n = 131 families; child age 5.7 ± 1.8 years) tested the efficacy of continuous glucose monitoring (CGM) with a family behavioral intervention (CGM+FBI) compared to CGM alone; a crossover group received usual care followed by CGM+FBI [10 ▪▪ ]. The FBI consisted of five sessions addressing common challenges encountered by parents of young children using T1D technology.…”

“…With respect to glycemia, nine studies reported favorable changes [12 ▪ ,13 ▪▪ ,14 ▪ ,15 ▪ ,22 ▪ ,23,26 ▪ ,28 ▪▪ ,30 ▪▪ ], seven found no change [9,10 ▪▪ ,16 ▪ ,18,19 ▪ ,21,31 ▪ ], and one reported an increase in HbA1c among intervention recipients [20 ▪ ]; five studies did not evaluate or report glucose metrics [8 ▪ ,24,25 ▪▪ ,27 ▪ ,29 ▪ ]. Psychosocial care is important independent of its relationship to glucose, and should be provided irrespective of the likelihood of improving glycemia.…”