Frequency of Mealtime Insulin Bolus as a Proxy Measure of Adherence for Children and Youths with Type 1 Diabetes Mellitus

Abstract

Background: Electronic measures of adherence can be superior to patient report. In type 1 diabetes, frequency of blood glucose monitoring (BGM), as measured by patients' home blood glucose meters, has already been identified as a valid proxy of adherence. We present methodology to calculate adherence using insulin pump records and evaluate the reliability and validity of this methodology. Subjects and Methods: Blood glucose meter data, insulin pump records, and corresponding hemoglobin A1c (HbA1c) levels were randomly gathered from clinical and research databases for 100 children and youths (referred to hereafter as youths) with type 1 diabetes (mean -SD age, 12.7 -4.6 years). Youths' mean frequency of daily BGM was calculated. Additionally, we calculated a mean mealtime insulin bolus score (BOLUS): youths received 1 point each for a bolus between 0600 and 1000 h, 1100 and 1500 h, and 1600 and 2200 h (maximum of 1 point/meal or 3 points/day). Results: Simple correlations between youths' HbA1c level, age, frequency of BGM, and insulin BOLUS scores were all significant. Partial correlations and multiple regression analyses revealed that insulin BOLUS scores better explain variations in HbA1c levels than the electronically recorded frequency of daily blood glucose measures. Conclusions: Our procedures for calculating insulin BOLUS scores using insulin pump records demonstrate better concurrent validity with youths' HbA1c levels than that of the frequency of BGM with youths' HbA1c levels. Our analyses have shown that insulin bolus scoring was superior to the frequency of BGM in predicting youths' HbA1c levels.

“I Don’t Want Them to Feel Different”: A Mixed Methods Study of Parents’ Beliefs and Dietary Management Strategies for Their Young Children with Type 1 Diabetes Mellitus

“…Consistent with a previous study, parents’ Child Frequency Scores were negatively correlated with children's HEI-2010 Total Scores (r=−0.48, p<0.05), suggesting child mealtime problems may be a barrier to healthful eating. 24 …”

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

“…Moreover, this study adds to a growing literature that uses objective data to evaluate insulin bolus adherence and it is 1 of very few studies to use data downloaded from insulin pumps in children and adolescents with T1D to evaluate adherence behaviors. 9,10 Several explanations may account for the increase in insulin pump adherence behaviors in parents of young children, who bear primary responsibility for diabetes care, as the date of the clinic visit approached. The clinic visit and contact with the diabetes care team may serve as a "trigger" or prompt, resulting in increased insulin pump adherence.…”

Frequency of Mealtime Insulin Bolus Predicts Glycated Hemoglobin in Youths with Type 1 Diabetes

“…15 The BOLUS is a measure of missed mealtime insulin boluses and follows a line of research that has shown an association between missed mealtime boluses and poorer glycemic control in youths. 9,[16][17][18] In this study, we investigated how BGM and the BOLUS perform in predicting youths' HbA1c values prospectively up to 12 months post-measurement of adherence. Consistent with our hypothesis, youths' predicted HbA1c values based on their baseline BOLUS scores correlated strongly and significantly with youths' actual HbA1c levels up to 12 months post-baseline, whereas youths' predicted HbA1c values based on their baseline BGM scores did not correlate as well with their actual HbA1c levels.…”

“…In particular, two electronic measures of self-care adherence have emerged in the literature: frequency of daily blood glucose monitoring (BGM) 8 and mean mealtime insulin bolusing (BOLUS). 9 In a cross-sectional study, both of these electronic measures were found to correlate negatively with youths' HbA1c, suggesting more frequent blood glucose testing and more frequent mealtime insulin bolusing were related to lower HbA1c levels. However, in a direct comparison, youths' BOLUS scores were found to be superior to daily BGM in explaining the variance in youths' HbA1cs when measured concurrently.…”