medwireNews: Involving older children with type 1 diabetes in the decision-making process about starting continuous glucose monitoring (CGM) may help to ensure that they persist with the technology, report researchers.
“Facilitating youth’s active involvement in decisions about the treatment regimen sends the message that his or her role is important and may foster a sense of competence with respect to type 1 diabetes management, including use of advanced technologies,” say Victoria Miller (Children’s Hospital of Philadelphia, Pennsylvania, USA) and co-workers.
“However, this relationship is likely to be bidirectional, with youth who are more confident being more likely to speak up in treatment-related discussions with their parents and providers.”
The researchers identified 108 parent–child dyads in which the child was aged between 8 and 17 years and newly starting CGM with the Dexcom G4/5 or G6.
As expected, the children’s CGM use significantly declined between weeks 5 and 12, with the average number of days of use per week falling from 5.34 to 4.32, representing an average decrease of 0.15 days/week and a predicted overall decline of 1.2 days.
After CGM initiation, the parent–child pairs had completed the Decision-Making Involvement Scale. This revealed that each 1-point increase in the Child Express subscale as reported by the parent was associated with a 0.96-day increase in CGM use between weeks 5 and 12.
“In other words, when parents reported that children spoke up more in discussions about CGM, by sharing information and opinions about CGM, children had higher days of use at follow-up,” the team summarizes in Diabetes Care.
Conversely, the more the parent spoke according to their own report, the less likely the child was to later use CGM, with each 1-point increase in the Parent Express subscale associated with a 0.87-day reduction in use.
At follow-up, the children completed the CGM Satisfaction Scale to assess their perceptions of the benefits and hassles of CGM, and the CGM Self-Efficacy survey. As expected, higher ratings for CGM self-efficacy and benefit, and a lower rating for hassle, were significantly associated with more days of use.
Indeed, self-efficacy and perceived hassle proved particularly important predictors of days of CGM use. In mediation analyses, the former accounted for 28% of the effect of the Child Express subscale on days of CGM use, and the latter accounted for 17%.
Miller and colleagues therefore stress the importance of fully involving older children in decisions about starting CGM, including assessing their expectations and addressing any misconceptions.
They add: “Providers can also encourage parents to engage their children in discussions about the decision and avoid dominating discussions about CGM, which may increase the likelihood that they are in agreement about waiting or proceeding with device initiation.”
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Diabetes Care 2020; doi:10.2337/dc20-0348