White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps

Driscoll, Kimberly A.; Wang, Yuxia; Johnson, Suzanne Bennett; Lynch, Richard; Stephens, Haley F.; Willbur, Katelyn; Gill, Elizabeth; Wright, Nancy A.; Deeb, Larry C.

doi:10.1177/1932296815623568

Cited by 24 publications

(34 citation statements)

References 12 publications

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“…Fifth, we used the most recent 14 days of data to calculate SMBG, which may be subject to white coat adherence bias. Although recent research shows that white coat adherence in the context of SMBG is largely limited to young children, future research should examine the present findings with SMBG data over an extended time.…”

Section: Discussionmentioning

confidence: 86%

Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes

et al. 2016

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Objective: To examine whether self-efficacy buffers the deleterious consequences of diabetes-specific family conflict on self-monitoring blood glucose (SMBG) and HbA1c in youth with type 1 diabetes mellitus (T1DM). Methods: A total of 129 youth with T1DM (aged 10–16 years) completed measures of diabetes-specific family conflict and self-efficacy for diabetes management, and their blood glucose meter data and HbA1c were extracted from the electronic medical record. We preformed moderation analyses to examine whether self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. We used simple slopes analyses to probe significant interactions. Results: Our results indicated that self-efficacy moderated the association that diabetes-specific family conflict had with SMBG and HbA1c. The pattern of these findings showed that high self-efficacy buffered the negative impact of diabetes conflict on HbA1c. However, benefits of high self-efficacy for more frequent SMBG was only apparent in the context of low diabetes-specific family conflict. Conclusions: Study findings highlight the interactive relationship between diabetes-specific family conflict and self-efficacy in relation to SMBG and glycemic control. These findings suggest that family functioning and youth’s self-efficacy are promising intervention targets for families having trouble with SMBG and HbA1c.

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Section: Discussionmentioning

confidence: 86%

Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes

et al. 2016

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“…Examination of the relationships between specific T1D self-management behaviors (e.g., blood glucose checking, carbohydrate inputs, and insulin bolusing) using objectively downloaded data from blood glucose monitors and insulin pumps has also been conducted [51, 52]. In general, children and adolescents demonstrate higher frequency of bolusing than to blood glucose checks and carbohydrate inputs [51, 53]. Although the combination of blood glucose checks, carbohydrate inputs, and insulin bolusing are essential to T1D self-management, these three insulin pump adherence behaviors are only completed 29–45% within a specified amount of time [51, 52].…”

Section: Biopsychosocial Factors Associated With Cgm and Insulin Pumpmentioning

confidence: 99%

“…Youth without wireless compatible blood glucose monitors do not input a substantial number of blood glucose results into their pumps, demonstrating the importance of using wireless monitors in T1D care as a tool to reduce the burden of additional manual steps [54]. Finally, a series of studies demonstrated that the frequency of blood glucose checks, carbohydrate inputs, and insulin bolusing increases before the T1D clinic visit (i.e., white coat adherence) [53, 55, 56]. …”

Section: Biopsychosocial Factors Associated With Cgm and Insulin Pumpmentioning

confidence: 99%

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

et al. 2018

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Purpose of Review Summarize biopsychosocial factors associated with using continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas (AP) systems and provide a “call to the field” about their importance to technology uptake and maintained use. Recent Findings Insulin pumps and CGMs are becoming standard of care for individuals with type 1 diabetes (T1D). AP systems combining a CGM, insulin pump, and automated dosing algorithm are available for commercial use. Despite improved glycemic control with AP system use, numerous barriers exist which may limit their benefit. Studies on components of AP systems (pumps, CGMs) are limited and demonstrate mixed results of their impact on fear of hypoglycemia, adherence, quality of life, depression and anxiety, and diabetes distress. Studies examining biopsychological factors associated specifically with sustained use of AP systems are also sparse. Summary Biological, psychological and social impacts of AP systems have been understudied and the information they provide has not been capitalized upon.

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“…Several studies have used glucose meter and/or CSII downloads to assess the frequency of BG monitoring, insulin bolus delivery, carbohydrate consumption, bolus calculator use, and meal-time bolus. [9][10][11][12] While these studies used objectively measured data, the methods for quantifying adherence relied on manual and time-intensive extraction of information provided by vendor-specific reports from different device manufacturers. However, vendor-specific reports have been scrutinized for lacking actionable information for providers related to other SMBs that may influence glycemic control and fail to provide insight into what the patient's rationale was for the actions and adaptations taken.…”

Section: Background and Significancementioning

confidence: 99%

“…Moreover, and partly as a result of these challenges, there are scarce data regarding adherence to CSII therapy and SMBs among adults with T1DM, as prior qualitative and quantitative studies have focused primarily on children or young adults. 5,6,[9][10][11][12][16][17][18] While recent evidence shows that there is considerable variability of SMBs within and between adult patients with T1DM on insulin pump therapy who use CSII, [19][20][21][22] current behavioral interventions are mostly based on the "one size fits all" approach of standardized diabetes self-management education. 1 This is unfortunate since individuals are more likely to follow self-management protocols that take their lifestyle preferences into account.…”

Section: Background and Significancementioning

confidence: 99%

Data-Driven Diabetes Education Guided by a Personalized Report for Patients on Insulin Pump Therapy

et al. 2020

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Objective It is difficult to assess self-management behaviors (SMBs) and incorporate them into a personalized self-care plan. We aimed to develop and apply SMB phenotyping algorithms from data collected by diabetes devices and a mobile health (mHealth) application to create patient-specific SMBs reports to guide individualized interventions. Follow-up interventions aimed to understand patient's reasoning behind discovered SMB choices. Methods This study deals with adults on continuous subcutaneous insulin infusion using a continuous glucose monitor (CGM) who self-tracked SMBs with an mHealth application for 1 month. Patient-generated data were quantified and an SMB report was designed and populated for each participant. A diabetes educator used the report to conduct personalized, data-driven educational interventions. Thematic analysis of the intervention was conducted. Results Twenty-two participants recorded 118 alcohol, 251 exercise, 2,661 meal events, and 1,900 photos. A patient-specific SMB report was created from this data and used to conduct the educational intervention. High variability of SMB was observed between patients. There was variability in the percentage of alcohol events accompanied by a blood glucose check, median 79% (38–100% range), and frequency of changing the bolus waveform, median 11 (7–95 range). Interventions confirmed variability of SMBs. Main emerging themes from thematic analysis were: challenges and barriers, motivators, current SMB techniques, and future plans to improve glycemic control. Conclusion The ability to quantify SMBs and understand patients' rationale may help improve diabetes self-care and related outcomes. This study describes our first steps in piloting a patient-specific diabetes educational intervention, as opposed to the current “one size fits all” approach.

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White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps

Cited by 24 publications

References 12 publications

Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes

Diabetes conflict outstrips the positive impact of self-efficacy on youth adherence and glycemic control in type 1 diabetes

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

Data-Driven Diabetes Education Guided by a Personalized Report for Patients on Insulin Pump Therapy

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