Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use

Wong, Jessie J.; Barley, Regan C.; Hanes, Sarah; Tanenbaum, Molly L.; Lanning, Monica S.; Naranjo, Diana; Hood, Korey K.

doi:10.1089/dia.2019.0492

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…Similar to cost considerations reported for intermittently scanned CGM, CGM may be able to offset monthly costs of test strips thereby offering a potential cost neutral solution for broadening access while improving outcomes 23‐25 . For those who were self‐discontinuers, improvements in adhesives, customizable alarm thresholds, and factory calibration which obviate the need for fingerstick blood glucoses with newer generation CGM, may improve adherence and use of CGM technology 26,27 …”

Section: Discussionmentioning

confidence: 96%

“…11,19 Findings from this study suggest that ongoing and uninterrupted use of CGM is a modifying factor in the relationship between CGM and HbA1c. Therefore, these data raise important con- 26,27 There are limitations to this study including the retrospective design and a single site. There are likely limitations to generalizability because providers at Stanford Children's have a tendency to encourage diabetes technology adoption for all youth using insulin, although diabetes technology use is increasing across the US.…”

Section: Discussionmentioning

confidence: 97%

“…With newer factory calibrated devices, adherence to device use will likely show further improvement. 26,27 The never user and user groups have differences at baseline, including differences in SMBG, insulin pump use, and baseline HbA1c. The most likely explanation for this observation is that California's public insurers require three checks per day in order to cover CGM and four checks per day are required to reimburse insulin pump use.…”

Section: Discussionmentioning

confidence: 99%

“…These data include youth with older generation CGM (Dexcom G4 and G5) and the Medtronic Guardian which required SMBG for CGM calibration and/or insulin dosing decisions. With newer factory calibrated devices, adherence to device use will likely show further improvement 26,27 . The never user and user groups have differences at baseline, including differences in SMBG, insulin pump use, and baseline HbA1c.…”

Section: Discussionmentioning

confidence: 99%

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Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

et al. 2020

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Objective: Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance. Methods: We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two-week CGM data were collected. Youth were classified as never user, consistent user, insurance discontinuer, and selfdiscontinuer. Visits were categorized as never-user visit, visit before CGM start, visit after CGM start, visit with continued CGM use, visit with initial loss of CGM, visit with continued loss of CGM, and visit where CGM is regained after loss. Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c. Results: Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start) was lower for visit after CGM start (−0.39%;[95%CI −0.78,−0.02]) and visit with continued CGM use (−0.29%;[95%CI −0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI −0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]). Conclusions: Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance. K E Y W O R D S diabetes technology, health policy, insurance, minority health, pediatric type 1 diabetes 1 | INTRODUCTION Optimal glucose control paired with improved quality of life is an important management goal for youth with type 1 diabetes (T1D) and providers who care for them. 1-3 Incorporation of continuous glucose This work was previously presented in a poster abstract form at the International Society for Pediatric and Adolescent Society's 45th Annual Conference.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

et al. 2020

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“…In den nächsten Jahren sind weitere technische Verbesserungen zu erwarten. Einstellungen der Nutzer/-innen und auch Betreuungspersonen gegenüber technischen Hilfsmitteln, psychologische und technische Aspekte spielen in der Akzeptanz dieser Hilfsmittel eine große Rolle [46,51,52]. In den nächsten Jahren wird sich zeigen, ob auch automatisierte Insulinpumpen-CGM-Systeme eine ähnlich starke Verbreitung wie Insulinpumpen und CGM-Systeme finden werden und auch Patientengruppen, die moderne technische Hilfsmittel bisher in nur begrenztem Umfang nutzten, vermehrt von neuen Technologien profitieren können.…”

Section: Diskussionunclassified

Insulinpumpe, kontinuierliche und kapilläre Glukosemessung bei Kindern, Jugendlichen und Erwachsenen mit Diabetes mellitus: Daten des DPV-Registers zwischen 1995 und 2019

Schöttler

Auzanneau

Best³

et al. 2020

Diabetologie und Stoffwechsel

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ZusammenfassungZiel dieser Beobachtungsstudie ist die Beschreibung der aktuellen Nutzung von Diabetestechnologien bei Patienten/-innen mit Diabetes mellitus. Methode Auswertung von Daten des DPV-Registers zur Nutzung der Insulinpumpentherapie (CSII), kontinuierlicher Glukosemessung (CGM) und der Selbstmessung der Blutglukose (SMBG) aus 497 teilnehmenden Zentren in Deutschland, Österreich, Luxemburg und der Schweiz zwischen 1995 und 2019. Die Daten wurden bei Patienten/-innen mit Diabetes Typ 1 (Alter ≥ 0,5 Jahre) für 5 Altersgruppen ausgewertet. Zusätzlich wurden aktuelle (zwischen 2017 und 2019) Geschlechtsunterschiede in der Verwendung von Diabetestechnologie bei Typ-1-Patienten/-innen untersucht, ebenso wie die Nutzung von Insulinpumpen und CGM für Patienten/-innen mit Insulintherapie bei Typ-2-DM, bei zystischer Fibrose (CFRD), bei anderen Pankreaserkrankungen, neonatalem Diabetes und Maturity Onset Diabetes of the Young (MODY). Ergebnisse Es zeigte sich bei Patienten/-innen mit Diabetes Typ 1 ein Anstieg der CSII-Nutzung von 1995 bis 2019 von 1 % auf 55 % (2019: < 6 Jahre: 89 %; 6–< 12 Jahre: 67 %; 12–< 18 Jahre: 52 %; 18–< 25 Jahre: 48 %; ≥ 25 Jahre: 34 %). Die CGM-Nutzung erhöhte sich ab 2016 bis 2019 von 9 % auf 56 % (2019: 67 %; 68 %; 61 %; 47 %; 19 % der jeweiligen Altersgruppe). Die SMBG nahmen von 1995 bis 2015 insbesondere in den jüngeren Altersgruppen zu, gefolgt von einem Rückgang seit dem Jahr 2016 (Alle Patienten: 1995: 3,3/Tag; 2016: 5,4/Tag; 2019: 3,8/Tag). Weibliche Patienten mit Typ-1-Diabetes führten häufiger eine CSII und mehr SMBG als männliche Patienten durch (56 %/48 %, jeweils p-Wert: < 0,0001), während sich bei der CGM-Nutzung keine signifikanten Unterschiede zeigten.Zwischen 2017 und 2019 erfolgte eine Nutzung von Insulinpumpen und CGM bei neonatalem Diabetes (CSII 87 %; CGM 38 %), bei MODY (CSII 14 %; CGM 28 %) und bei CFRD (CSII 18 %; CGM 22 %). CGM und CSII wurden dagegen nur selten von Menschen mit Insulintherapie und Diabetes Typ 2 (CSII < 1 %; CGM 1 %) und bei anderen Pankreaserkrankungen (CSII 3 %; CGM 4 %) genutzt. Schlussfolgerung Moderne Diabetestechnologien werden derzeit insbesondere von pädiatrischen Patienten/-innen mit Diabetes Typ 1, aber auch von Menschen mit neonatalem Diabetes breit genutzt, von Patienten/-innen mit MODY und CFRD sowie Erwachsenen mit Diabetes Typ 1 in etwas geringerem Maße mit ansteigendem Trend. Dagegen sind diese Technologien in der Therapie des Typ-2-Diabetes und bei anderen Pankreaserkrankungen zurzeit nur wenig verbreitet.

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Patterns of Continuous Glucose Monitor Use in Young Children Throughout the First 18 Months Following Type 1 Diabetes Diagnosis

Sinisterra

Wang

Marks

et al. 2021

Diabetes Technology & Therapeutics

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Objective: To describe sociodemographic and parent psychosocial characteristics associated with patterns of continuous glucose monitor (CGM) use across the first 18 months post-type 1 diabetes (T1D) diagnosis among young children. Methods: One hundred fifty-seven parent-child dyads enrolled in a behavioral intervention for parents of young children (1-6 years) newly diagnosed with T1D. Parents reported on baseline sociodemographic characteristics and psychosocial functioning; child CGM use was assessed at five time points during the first 18 months postdiagnosis. Results: Most participants (81.8%) used CGM at least once. Four CGM trajectories emerged (always, later/ stable, inconsistent, and never). Participants with private insurance were more likely to be in the always, later/stable, or inconsistent groups versus the never group. Youth in the always and later/stable groups had lower mean HbA1c at 18 months than those in the never group. Conclusions: Given the health benefits of CGM, further exploration of barriers to CGM use in families with public health insurance is needed. ClinicalTrials.gov identifier: NCT02527525

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Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use

Cited by 9 publications

References 19 publications

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

Insulinpumpe, kontinuierliche und kapilläre Glukosemessung bei Kindern, Jugendlichen und Erwachsenen mit Diabetes mellitus: Daten des DPV-Registers zwischen 1995 und 2019

Patterns of Continuous Glucose Monitor Use in Young Children Throughout the First 18 Months Following Type 1 Diabetes Diagnosis

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