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White Coat Adherence in Pediatric Patients With Type 1 Diabetes Who Use Insulin Pumps

Kimberly A Driscoll1, Yuxia Wang2, Suzanne Bennett Johnson2

  • 1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA kimberly.driscoll@ucdenver.edu.

Journal of Diabetes Science and Technology
|January 10, 2016
PubMed

Insights

Younger children with type 1 diabetes (T1D) may show "white coat adherence," improving treatment regularity before clinic visits. This behavior, observed in blood glucose monitoring and insulin use, can skew adherence data in pediatric diabetes management.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Technology
  • Behavioral Science in Medicine

Background:

  • Type 1 diabetes (T1D) management requires consistent adherence to treatment regimens.
  • Insulin pump therapy is common in pediatric T1D care.
  • Understanding adherence patterns is crucial for effective diabetes management.

Purpose of the Study:

  • To investigate the phenomenon of "white coat adherence" in children and adolescents with T1D using insulin pumps.
  • To determine if adherence to treatment increases specifically before clinic appointments.
  • To identify factors influencing white coat adherence in this population.

Main Methods:

  • Retrieved blood glucose monitoring (BGM) data, carbohydrate inputs, and insulin boluses from insulin pumps.
  • Analyzed data from 2 consecutive clinic visits for patients aged 7-19 years with T1D.
  • Utilized linear mixed models to assess patterns in BGM, carbohydrate intake, and insulin delivery over ≥28 days of stored data.

Main Results:

  • Younger children demonstrated more frequent BGM, carbohydrate logging, and insulin delivery compared to older children and adolescents.
  • White coat adherence was observed in the frequency of BGM, carbohydrate inputs, and insulin boluses delivered.
  • This increased adherence before appointments was specifically noted in younger children.

Conclusions:

  • Healthcare providers should recognize the potential for white coat adherence, especially in young children with T1D.
  • Routine downloading of insulin pump data may capture an inflated view of adherence.
  • Awareness of this behavior is essential for accurate assessment of treatment adherence in pediatric diabetes care.
Abstract

Keywords:
adherenceadolescentsblood glucosecarbohydrate inputschildreninsulin bolusing

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