Children use CGM more often when allowed to participate in treatment decisions
Click Here to Manage Email Alerts
Children and adolescents with type 1 diabetes use continuous glucose monitoring for more days and have greater confidence when their parents involve them in the decision to initiate the device, according to a study published in Diabetes Care.
“Children and adolescents should be the ones driving the decision about whether or not to start CGM, because they will be more likely to use the device consistently,” Victoria A. Miller, PhD, a psychologist and associate professor of pediatrics, medical ethics and health policy at the Perelman School of Medicine at the University of Pennsylvania, told Healio. “Parents and clinicians can facilitate their involvement by encouraging youth to ask questions, express concerns and make the final decision about CGM. For many youth, this was a decision that was discussed and revisited over a long period of time before ultimately starting the device.”
Miller and colleagues recruited 108 children (49 girls) and their parent or caregiver between June 2017 and April 2019. Children were between the ages of 8 and 17 years (mean age = 13.4 years) and had type 1 diabetes for at least 6 months prior to initiating CGM. All the participants spoke English, were willing to start CGM within 3 days of completing the initiation training and used either an insulin pump or basal-bolus injections.
Within 1 month of receiving the medical necessity letter for CGM, both the children and parents completed a decision-making involvement scale in which they answered questions about their discussion on CGM use. The response options were “not at all,” “a little bit,” “quite a bit” and “a lot.” Each question was answered on five subscales: parent seeking of information, parent expression of opinion, child seeking of information, child expression of opinion and joint discussion.
At a follow-up 2 months after CGM use began, youth participants answered questions about their satisfaction with CGM use and a self-efficacy survey to measure their confidence. Researchers documented each participants’ use of CGM during weeks 5 through 12.
Parental reports about their child expressing opinions was associated with an increase in the number of days the device was used with each point increase in that measure correlated with 0.96 days of increased use (P < .0001). Surveys including parental expression of opinion resulted in 0.87 fewer days of use for each point increase (P = .0064).
Children also used their CGM more frequently when they reported higher self-efficacy (P < .0001), higher CGM benefit (P < .0001) and lower CGM hassle (P = .0026).
“Parents of youth with a chronic illness sometimes struggle with when and how to provide decision-making independence when it comes to the child’s chronic illness,” Miller said. “These findings are relevant to both parents and clinicians by underscoring the importance of involving youth in decision making about CGM, as well as other medical decisions.”
Miller said future research should explore intervention strategies to encourage more youth involvement with CGM and other type 1 diabetes issues. Additionally, 72.9% of this study’s participants were white and more than half had an income of more than $100,000. Miller said another study should also look at a more diverse ethnic and socioeconomic groups to assess whether there are any differences in the decision-making process.
For more information:
Victoria A. Miller, PhD, can be reached at millerv@email.chop.edu
Collapse
Click Here to Manage Email Alerts