568-P: Living With Diabetes—A Hands-on Workshop
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Background: Diabetes affects 37.3 million people, with a total estimated cost of $327 billion. Studies have shown significant knowledge gaps in resident education regarding diabetes management, resulting in medical errors and inappropriate care. Although studies show that hands-on diabetes education is beneficial, most curricula are delivered as online, self-paced, or case-based learning, without insight into the day-to-day management of diabetes. Description: Using personal experience of living with diabetes as a unique educational tool, we created an education session to share the patient experience of daily diabetes tasks, teach diabetes management skills, and foster peer teaching. The hour-long interactive session included an introduction about the presenter’s experience with diabetes and three 15-minute hands-on sessions, where participants counted their own carbohydrates for a meal, tested their blood sugar and/or tried on a Dexcom G7 sensor, and put on an insulin pump site. Methods: We presented the session to pediatric residents and clerkship students, and surveyed participants on their understanding of diabetes care before and after the session and their overall rating of the session. Results: A total of 17 participants answered the pre-session survey and 7 answered the post-session survey. Prior to the session, the proportion of participants indicating they somewhat or strongly agreed they knew what it felt like to check a blood glucose, give an insulin injection or pump insertion, or to perform the work of carbohydrate counting was 53%, 18%, and 29%; post-session these proportions increased to 100%, 100%, and 86% respectively. All the post-session respondents somewhat or strongly agreed they found the session valuable and would recommend to other residents. Discussion: The session increased participants’ understanding of daily tasks of diabetes management and was perceived as a valuable part of residency education. Future directions include expanding to internal medicine and family practice residents. Disclosure A. Jenkins: None. J.N. Todd: None.Keywords:
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Blood sugar
Continuous subcutaneous insulin infusion delivered via a pump is increasingly recommended for younger children with Type 1 diabetes. Our aims were: to understand the impact on parents who care for young children using insulin pumps; to help interpret psychological outcomes reported in quantitative research; and to inform provision of support to future parents.We conducted in-depth interviews with 19 parents of children (aged ≤ 12 years) with Type 1 diabetes who used an insulin pump. Data were analysed thematically.Parents reported multiple benefits from using insulin pumps, including: no longer having to administer painful injections; fewer restrictions on the frequency, timing and carbohydrate contents of snacks and meals; and improvements in family life and their child's glycaemic control. Parents liked and felt less anxious about using bolus calculators to determine insulin doses; however, parents also described undertaking additional and unanticipated work to manage their child's diabetes using a pump. This included performing more blood glucose tests to calculate insulin doses for snacks and to address their concerns that the pump increased their child's risk of hypoglycaemia. Some parents reported doing additional blood glucose checks because they could adjust pump settings to better manage hypo- and hyperglycaemia.Parents liked and perceived benefits for their child and themselves from using an insulin pump; however, parents would benefit from being made aware of the additional work involved in using a pump and also from education and support to address concerns about hypoglycaemia. Better measures to evaluate parents' experiences are also recommended.
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Background: Managing type 1 diabetes (T1D) in young children presents challenges to families and caregivers. Pump therapy may reduce challenges and benefit glycemic control. However, pump use is not universal; parent-reported reasons for lack of uptake are not well described. Methods: Parents of children <7, with T1D for ≥1 year, in the T1D Exchange registry completed surveys capturing demographic and clinical characteristics, as well as barriers to pump use. Data from pump users were compared to nonusers, and barriers were analyzed among parents who received pump recommendations, but decided against uptake. Results: Young children (N = 515) from 41 sites were identified (mean age 5.2 ± 1.2 years, diabetes duration 2.4 ± 1.0 years, 46% female, and 78% Non-Hispanic White). Overall glycemic control was suboptimal (HbA1c 8.1% ± 1.0%). The majority were pump users (64%, n = 331; nonusers 36%, n = 184). Pump users had longer T1D duration (2.5 ± 1.1 years vs. 2.2 ± 1.0 years, P = 0.001), were more likely to have annual household incomes ≥$75,000 (62% vs. 36%, P < 0.001), have a parent with college education or higher (70% vs. 45%, P < 0.001), perform more frequent blood glucose monitoring (7.5 ± 2.5 times/day vs. 6.5 ± 2.3 times/day, P < 0.001), and use continuous glucose monitoring (CGM) (45% vs. 13%, P < 0.001). Only income, education, frequency of blood glucose monitoring, and CGM use remained significant in a multivariate model including age, sex, ethnicity, and duration of diabetes. Barriers to pump uptake included concerns with physical interference, therapeutic effectiveness, and to a lesser extent, financial burden. Conclusions: These findings provide an opportunity to address potentially modifiable parent-reported barriers to pump uptake through education and behavioral intervention.
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Insulin pump therapy has, within the last 10 years, emerged as an increasingly popular modality of treatment to achieve intensive glycemic targets in type 1 diabetes (T1D). The evidence for the benefits of pump therapy has been demonstrated in adults and adolescents; however, until recently there has been a paucity of studies examining the efficacy and safety in pump therapy in very young children. The purpose of this article is to discuss the rationale for insulin pump therapy in infants and toddlers, review the available studies of pump therapy in this population, and show that the data support the use of insulin pumps in our very youngest of patients.
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Abstract Type 1 diabetes (T1D) is a common illness of childhood, requiring lifelong, daily complex management to prevent acute and chronic complications. Studies have shown that use of insulin pumps and continuous glucose monitors (CGM) offers benefit for glycemic control. However, such device use is not universal in adolescents. We aimed to compare baseline socio-demographic and diabetes characteristics associated with diabetes technology (pump and CGM) uptake and continued use in 13-17 year old teens with T1D. Data were derived from a multicenter clinical trial aimed at optimizing self-care and glycemic control in teens with T1D. Socio-demographic and diabetes data were collected quarterly by parent-youth interview and electronic medical record review prospectively over 18 months. Chi-square and t-tests compared characteristics of device and non-device users (pump vs no pump; CGM vs no CGM). The study sample comprised 301 teens (41% male) with mean±SD age 15.0±1.3 years, T1D duration 6.5±3.7 years, and A1c 8.5±1.1%. Most (65%) used a pump at entry or initiated pump therapy during the study; 35% used injection therapy at entry or stopped pump therapy. In contrast, 27% used a CGM at entry or started a CGM during the study, while 73% never used or stopped using CGM. Device users at entry and those who began use had similar characteristics, as did those who never used and those who discontinued device use. Pump users were more likely to use CGM than non-pump users (36% vs 10%, p<.0001). Neither age, sex, nor T1D duration was related to pump or CGM use. Pump users (vs non-pump users) were less likely to have another medical condition (44% vs 59%, p=.01) and more likely to be non-Hispanic white (83% vs 61%, p=.0001); have family annual household income ≥$150,000 (34% vs 19%, p=.0003), private health insurance (92% vs 74%, p<.0001), a parent with college education or higher (67% vs 46%, p=.0005), and a 2-parent household (88% vs 78%, p=.03). Pump users also had lower z-BMI (0.73±0.80 vs 0.97±0.79, p=.01), performed more frequent daily BG monitoring (4.8±1.8 vs 3.9±2.0, p<.0001), and were less likely to have HbA1c ≥9% at initial and last visits (25% vs 43%, p=.005; 31% vs 49%, p=.01). CGM users (vs non-CGM users) were more likely to be non-Hispanic white (88% vs 70%, p=.009); have family annual household income ≥$150,000 (44% vs 23%, p=.0001), a parent with college education or higher (78% vs 53%, p=.0004), and private health insurance (95% vs 82%, p=.005). CGM users also performed more frequent daily BG monitoring (5.2±1.9 vs 4.2±1.9, p=.0002) and were less likely to have HbA1c ≥9% after 18 months (27% vs 42%, p=.03). In summary, we found distinct socio-demographic and diabetes-specific factors associated with device use in adolescents with T1D. These findings provide an opportunity to address barriers associated with device non-use in order to expand device implementation, especially in underserved adolescents with T1D.
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Objective: Hypoglycemia Fear (FH) is common in parents of young children with T1D and related to poor child glycemic control. We explored if T1D device adoption near onset relates to parental FH. Methods: In a prospective study of 5-9 year-olds with new onset T1D (mean age 7.4±1.3 years, mean T1D duration 4.6±3.3 months), parents completed the FH Survey at baseline (T1) and 6 (T3) and 12 (T5) months post-baseline. We recorded pump start dates for youth during the same 12 months. Results: Between T1 and T3, 44 youth (45%) initiated pump therapy. Between T3 and T5, 12 (13%) started a pump. Forty-one youth never started a pump (42%). Despite pump status, parents reported moderate FH Worry at T1 (32.2±11.2), which increased between T1 and T3 (38.0±11.3, p=0.052) and plateaued between T3 and T5 (38.4±12.3, p=0.45). There was no difference in T1 FH Worry among the 44 parents of youth who started a pump between T1 and T3 and those not on a pump. At T3, FH Worry trended higher in the 12 parents whose child started a pump between T3 and T5 than the 85 parents of youth either already on a pump or not on one (p=0.059). At T5, the 12 parents whose child started a pump between T3 and T5 reported significantly higher FH Worry than the other parents (p=0.048). Conclusions: Parents of 5-9 year-olds with new onset T1D report moderate FH in the first year of T1D. Our results suggest that initiating pump therapy may not reduce parental FH. Table.Longitudinal measures of hypoglycemia fear and relation to initiation of insulin pump therapyNT1 (Baseline)T3 (6 months)T5 (12 months)Average Age (years)977.5 ± 1.4Gender (%F)10056 (56.0%)Pump Start (%)1000 (0%)44 (44.0%)12 (12.0%)FH Worry (total)8532.7 ± 11.738.0 ± 11.338.2 ± 12.1FH Worry (pump start T1-T3)4433.1 ± 11.135.9 ± 10.738.0 ± 12.3FH Worry (pump start T3-T5)1233.3 ± 12.743.7 ± 11.644.6 ± 7.98**p value <0. Disclosure E.M. Youngkin: None. S. Majidi: None. A. Noser: None. K.R. Stanek: None. J.H. Finch: None. M.A. Clements: Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Glooko, Inc.. S.R. Patton: None.
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The purpose of this study is to determine whether parental knowledge of the continuous subcutaneous insulin infusion (CSII) device affects glycemic control as measured by hemoglobin A1c (A1C) level.Parents of children with type 1 diabetes mellitus (T1DM) using CSII completed a 14-item questionnaire. Questions 1-10 were knowledge-based questions that required the parent to extract specific information from their child's CSII device. Questions 11-14 asked parents to provide a self-assessment of their CSII knowledge.Twenty-two parents of youth with T1DM participated in the study. Ten of the youth were in the Low-A1C group (A1C<8%), and the other 12 were in the High-A1C group (A1C≥8%). Parents of youth in the Low-A1C group scored statistically better on the 10-item performance survey than parents of youth in the High-A1C group. Most of the parents of children in the Low-A1C group responded that they knew their child's insulin pump "very well" and that their pump knowledge had "increased" since their child started on the insulin pump.Our findings reveal that youth with T1DM whose parents are more knowledgeable about pump functions have optimal glycemic control as evidenced by A1C. These findings underscore the importance of ongoing pump training for both pediatric patients and their parents.
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Background Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. Objective To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. Methods This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. Results Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). Conclusions Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
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