medwireNews: Children and adolescents with type 1 diabetes become more diligent about bolusing for insulin at mealtimes in the run-up to a clinic appointment, as reflected in objective data from their insulin pumps.
Awareness of this aspect of “white-coat adherence” is important, say Susana Patton (Nemours Children’s Health System, Jacksonville, Florida, USA) and co-researchers.
They point out that examining insulin pump data from only a couple of weeks prior to a clinic appointment “may give a false impression of a youth’s average daily level of [type 1 diabetes] self-management,” which could in turn “lead diabetes care teams to make a potentially suboptimal change to [a] youth’s insulin dosage.”
The team studied insulin pump data from 260 children and 199 adolescents (≥13 years), with an average glycated hemoglobin level of 8.4% (68 mmol/mol). The average BOLUS score, indicating how often in a day they took a carbohydrate-associated insulin bolus, was 2.15, on a scale of 0–3, but this changed with nearness to clinic visit, so that the score became significantly higher as the clinic visit drew nearer.
The effect was observed both for children and for adolescents, the researchers report in BMJ Open Diabetes Research & Care. They suggest that diabetes teams should consider looking at insulin pump data for at least 6 weeks prior to youths’ clinic visits, if not longer, to gain a realistic picture of their self-management behaviors and offer suitable support.
Although white-coat adherence, reflected in change in BOLUS score over time, affected both age groups equally, Patton and team found clear differences in overall commitment to insulin bolusing, with adolescents scoring significantly lower than children at all timepoints.
In children, the average BOLUS score was 2.20 across the fifth and sixth weeks prior to the clinic visit, rising to 2.35 for the third and fourth weeks, and 2.36 for the first and second weeks. The corresponding scores in adolescents were 1.88, 1.94, and 1.96.
“Because adolescents had significantly lower BOLUS scores than children across each time period, our [white-coat adherence] effects may be particularly clinically noteworthy when caring for adolescents,” write the researchers.
They point out that the differences between the age groups equates “to nearly five more missed mealtime boluses for adolescents in each 2 weeks period relative to that for children.”
And they speculate that knowledge of white-coat adherence could in fact be used to positive effect in adolescents.
“Namely, youth with [type 1 diabetes] may receive potential value from more frequent clinic appointments or from regular data sharing accompanied by contact with the youth’s diabetes care team between clinic visits,” they suggest.
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