Self‐management among pre‐teen and adolescent diabetes device users

Abstract

Objective: Despite increased diabetes device use, few adolescents with type 1 diabetes (T1D) meet glycemic targets. We examine associations between utilization of insulin pumps and continuous glucose monitoring (CGM) and glycemic control. Research Design and Methods: This prospective cohort study included 80 youths (10-18 years of age) with T1D. Multiple linear regression and linear mixed models (LMM) were used to estimate the effects of device self-management on HbA1c and daily time in range (70-180 mg/dL), respectively. Results: Every blood glucose (BG) input/day was associated with a 0.2% decrease in HbA1c (95% CI: −0.297, −0.013), each bolus/day was associated with a 0.2% decrease (−0.327, −0.057), and use of CGM was associated with a 0.5% decrease (−1.00, −0.075). Among CGM users (n = 45) every 10% increase in CGM use was associated with a 0.3% decrease in HbA1c (−0.390, −0.180). In LMM accounting for within subject and between subject variability, there was a negative association between BG input/day frequency (coefficient = −1.880, [−2.640, −1.117]) and time in range. Residual random effects for CGM users were large showing time in range varied between youth with a SD of 15.0% (3 hours and 36 minutes) (SE 2.029, [11.484, 19.530]). Time in range varied significantly from day-today with SD of 18.6% (4 hours and 40 minutes) (SE0.455, [17.690, 19.473]). Conclusions: Device self-management behaviors among youth are significantly associated with both HbA1c and time in range. Our findings showing an association between reduced time in range and increased self-management behaviors is novel and deserves further investigation. K E Y W O R D S adolescent, diabetes technology, insulin pump therapy, self-management, type 1 diabetes 1 | INTRODUCTION Despite increased insulin pump and continuous glucose monitoring (CGM) use, only 17% of adolescents with type 1 diabetes (T1D) meet glycemic targets as measured by glycosylated hemoglobin (HbA1c). 1 Insulin pump therapy can improve glycemic control and quality of life; 2,3 however, adolescents typically achieve little to no HbA1c reductions with insulin pump therapy. 4 Insulin pump therapy is a more physiologic form of insulin delivery than multiple daily injections, yet achieving successful outcomes depends in large part on individual proficiency, surveillance, and self-management behaviors. 5 Suboptimal management and unsafe pump behaviors can lead to a decline in glycemic control and contribute to adverse events. 6,7 Previous studies of adolescents' insulin pump utilization and self

Expect the unexpected: Adolescent and pre‐teens' experience of diabetes technology self‐management

“…The theme, “expect the unexpected,” helps to illuminate the youth's experience of daily glucose variability. In Strand et al (2018), youth described the phenomenon of glucose fluctuations as a 'roller coaster', which is consistent with the characterization by youth in our study 13 . This phenomenon of unpredictability is reflected in residual variance analysis from the quantitative portion of this mixed methods study.…”

“…In fact, youth's description of self‐management including their characterization of good versus bad days and their frustration over unexpected outcomes were strikingly similar. While youth's described experience was similar, the corresponding quantitative data from phase 1 of this mixed methods study showed frequency of self‐management behaviors (i.e., bolus, SMBG, advanced feature use) varied significantly between youth with high and low A1C 13 . Further exploration of this difference between youth's experience and application of self‐management behaviors is warranted.…”

“…24 Youth's descriptions of diabetes self-management during ''bad'' days are substantiated by our previously published quantitative findings from the larger sample of pre-teen and adolescent insulin pump users with CGM devices. 13 When daily time in range (TIR) was examined each insulin pump self-management task was, in fact, negatively associated with TIR. 13 On days when the youth experienced greater TIR (i.e., better glucose control), they performed fewer self-management tasks.…”

“…We conducted a sequential mixed method study conducted in two phases. Phase 1 quantitative results have previously been reported and included 80 youth (10‐18 years of age) with T1D>1 year on pump therapy for >6 months 13 In phase 2, semi‐structured interviews were conducted with youth between June 28, 2019, and February 5, 2020. The participant's personal insulin pump and CGM data were downloaded and served as a visual reference for participants to analyze and describe their self‐management behaviors and experiences.…”

From Consultant to Co-investigator: One Diabetes Research Team’s Journey of Patient Engagement

“…We aim to highlight the various roles taken by CDN members, their specific contribution to research, and any limitations identified. We discuss the CDN's role in two particular studies: the first, Mobile-app simulation platform for diabetes self-management, involved usability testing and development of a diabetes education technology, and the second, Self-management among Pre-teen and adolescent INsulin pump users (SPIN), which was a prospective mixed methods observational study examining pre-teen and adolescent diabetes technology selfmanagement (Faulds et al, 2020).…”