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Accuracy of blood glucose estimation by children with IDDM and their parents
L A Gonder-Frederick1, A L Snyder, W L Clarke
1Department of Behavioral Medicine, University of Virginia Diabetes Center, Charlottesville.
Insights
Children with insulin-dependent diabetes (IDDM) and their parents struggle to accurately recognize blood glucose symptoms and estimate glucose levels. Education and frequent self-monitoring of blood glucose are crucial for better management.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Clinical Psychology
Background:
- Accurate blood glucose monitoring is vital for managing insulin-dependent diabetes mellitus (IDDM).
- Symptom recognition and subjective glucose estimation by patients and caregivers are key components of self-management.
- Previous studies have focused on adolescents and adults, leaving a gap in understanding for younger children.
Purpose of the Study:
- To assess the accuracy of blood glucose symptom recognition in children with IDDM.
- To evaluate the reliability of subjective blood glucose estimation by both children with IDDM and their parents.
- To identify discrepancies between perceived and actual blood glucose control in pediatric diabetes management.
Main Methods:
- A sequential sample of 19 families with children under 12 years old with IDDM participated.
- Blood glucose estimation questionnaires were administered four times daily during routine home activities.
- Error grid analysis was employed to quantify the accuracy of subjective estimations against measured blood glucose levels.
Main Results:
- Both children with IDDM and their parents exhibited poor accuracy in blood glucose estimation, with frequent clinically significant errors.
- A common error was the failure to detect extreme blood glucose levels, particularly underestimating hyperglycemia.
- Children often reported hypoglycemia when their blood glucose was actually high; confidence in estimation ability did not correlate with accuracy.
Conclusions:
- Children with IDDM and their parents show higher error rates in glucose estimation than older IDDM populations.
- Self-reported accuracy in symptom recognition and glucose estimation should be approached with caution, even with frequent self-monitoring of blood glucose.
- Enhanced education on symptom recognition and glucose estimation errors is needed for families with IDDM children, alongside encouragement for using self-monitoring of blood glucose before treatment decisions.
Objective:
To evaluate the accuracy of blood glucose symptom recognition and subjective blood glucose estimation in insulin-dependent diabetic (IDDM) children and their parents.
Research Design And Methods:
Blood glucose estimation questionnaires were completed 4 times/day at home during routine activities. A sequential sample of 19 families, who attended a pediatric diabetes clinic, with IDDM children less than 12 yr old and IDDM duration of greater than or equal to 9 mo comprised the study.
Results:
Error grid analysis showed that both children and parents demonstrated poor accuracy, making clinically significant errors as frequently as clinically accurate estimates. The most common error was the failure to detect extreme blood glucose levels, with a significant tendency to underestimate hyperglycemia. Children often reported hypoglycemia when blood glucose was hyperglycemic. Confidence in the ability to estimate blood glucose was unrelated to measured accuracy.
Conclusions:
IDDM children and their parents demonstrated a higher rate of blood glucose estimation errors than IDDM adolescents and adults in previous studies. Even in families who use self-monitoring of blood glucose frequently, self-reported ability to recognize symptoms and estimate blood glucose should be viewed with caution. Families with IDDM children need more education about errors in symptom recognition and blood glucose estimation. They should also be encouraged to use self-monitoring of blood glucose before treating children's reported hypoglycemic symptoms whenever possible.