Division of Endocrinology and Diabetes, Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA.
College of Public Health, The University of Iowa, Iowa City, IA, USA.
J Diabetes Sci Technol. 2023 Mar;17(2):381-389. doi: 10.1177/19322968211059537. Epub 2021 Nov 22.
The majority of youth with type 1 diabetes (T1D) fail to meet glycemic targets despite increasing continuous glucose monitoring (CGM) use. We therefore aimed to determine the proportion of caregivers who review recent glycemic trends ("retrospective review") and make ensuant insulin adjustments based on this data ("retroactive insulin adjustments"). We additionally considered that fear of hypoglycemia and frequency of severe hypoglycemia would be associated with performing retrospective review.
We conducted a cross-sectional survey of caregivers of youth with T1D, collecting demographics, diabetes technology usage, patterns of glucose data review/insulin dose self-adjustment, and Hypoglycemia Fear Survey (HFS).
Nineteen percent of eligible caregivers (191/1003) responded. Performing retrospective review was associated with younger child age (12.2 versus 15.4, = .0001) and CGM use (92% versus 73%, = .004), but was not associated with a significant improvement in child's HbA1c (7.89 versus 8.04, = .65). Retrospective reviewers had significantly higher HFS-behavior scores (31.9 versus 27.7, = .0002), which remained significantly higher when adjusted for child's age and CGM use ( = .005). Linear regression identified a significant negative association between HbA1c (%) and number of retroactive insulin adjustments (0.24 percent lower mean HbA1c per additional adjustment made, = .02).
Retrospective glucose data review is associated with improved HbA1c when coupled with data-driven retroactive insulin adjustments. Barriers to data downloading existed even in this cohort of predominantly CGM-using T1D families.
尽管越来越多的青少年 1 型糖尿病（T1D）患者使用连续血糖监测（CGM），但仍有多数患者未能达到血糖目标。因此，我们旨在确定查看近期血糖趋势（“回顾性审查”）并根据这些数据调整胰岛素的照顾者比例。我们还认为，对低血糖的恐惧和严重低血糖的频率与进行回顾性审查有关。
我们对青少年 T1D 的照顾者进行了横断面调查，收集了人口统计学资料、糖尿病技术使用情况、血糖数据审查/胰岛素剂量自我调整模式以及低血糖恐惧调查（HFS）。
19%的合格照顾者（191/1003）做出回应。回顾性审查与孩子年龄较小（12.2 岁与 15.4 岁， =.0001）和 CGM 使用（92%与 73%， =.004）有关，但与孩子的 HbA1c 无显著改善相关（7.89 与 8.04， =.65）。回顾性审查者的 HFS-行为评分显著更高（31.9 与 27.7， =.0002），当调整孩子的年龄和 CGM 使用时，评分仍然显著更高（ =.005）。线性回归发现 HbA1c（%）与追加胰岛素调整次数之间存在显著负相关（每追加一次调整，HbA1c 平均降低 0.24%， =.02）。
当与数据驱动的回顾性胰岛素调整相结合时，回顾性血糖数据审查与 HbA1c 的改善相关。即使在使用 CGM 的 T1D 家庭中，数据下载也存在障碍。
