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Effects of enhanced conventional therapy on metabolic control in children with insulin-dependent diabetes mellitus
Insights
Behavior modification improved adherence to diabetes care routines in children, increasing negative urine tests. However, this did not significantly impact glycemic control or show differences between once- or twice-daily insulin injections.
Area of Science:
- Pediatric Endocrinology
- Behavioral Medicine
- Diabetes Management
Background:
- Type 1 diabetes requires intensive self-management, including adherence to diet, exercise, and insulin regimens.
- Improving self-regulation of adherence behaviors is crucial for optimal glycemic control in children.
Purpose of the Study:
- To assess the impact of a behavior modification program on self-regulation of adherence and insulin delivery in children with diabetes.
- To evaluate the effectiveness of once- vs. twice-daily insulin injections on glycemic control.
Main Methods:
- A 32-week, three-phase program involving behavior modification, feedback, and parent checks.
- Adherence measured using Clinitest placebos; glycemic control assessed via GHb, FBG, and lipids.
- Comparison of once-daily versus twice-daily insulin injections in matched pairs.
Main Results:
- Significant and sustained increase in negative urine tests observed.
- No significant changes in glycated hemoglobin (GHb) or fasting plasma glucose (FBG).
- Reliability and adherence to urine testing were 83% and 76%, respectively; no significant differences in insulin regimens.
Conclusions:
- Behavior modification enhanced adherence to diabetes care routines and increased negative urine tests.
- The program did not lead to improvements in overall glycemic control measures.
- Insulin regimen frequency (once vs. twice daily) did not show significant differences in this cohort.
Abstract:
We implemented a three-phase, 32-wk program to improve both self-regulation of adherence behaviors and insulin delivery in children with diabetes. Twenty children, aged 8-12 yr (mean duration 3.6 yr), enrolled. Phase 1 (wk 1-12) used behavior modification to improve diet, exercise, urine testing, and insulin adjustment, targeting an increased percentage negative urines. Feedback training and parent checks were used to improve reliability; adherence was measured using Clinitest placebos. Phase 2 (wk 13-20) was a stabilization period. Phase 3 (wk 21-32) studied the effect of insulin dose adjustment, comparing once-versus twice-daily shots in 10 pairs of children matched for %GHb. GHb, fasting plasma glucose, and lipids were measured at baseline and at the end of each phase. Results revealed a significant and sustained increase in negative urine tests, but no change in % GHb or FBG. Reliability of and adherence to urine tests were 83% and 76%, respectively. During phase 3, no significant differences were noted between groups receiving once- or twice-daily insulin injections. Thus, behavior modification resulted in increased reliability and adherence to routines, associated with a reliable increase in negative urines. This did not, however, produce changes in other control measures. Furthermore, no differences between those receiving 1 or 2 daily shots were evident.