Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.
Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, Indiana, USA.
Diabet Med. 2023 Aug;40(8):e15120. doi: 10.1111/dme.15120. Epub 2023 May 2.
Managing type 1 diabetes in young children can cause significant stress for parents. Continuous glucose monitoring (CGM) may reduce parental burden. The Strategies to Enhance CGM Use in Early Childhood (SENCE) trial randomized parents of children (ages 2 to <8 years) with type 1 diabetes to CGM with family behavioural intervention (CGM + FBI), CGM alone (Standard-CGM) or blood glucose monitoring for 26 weeks before receiving CGM + FBI (BGM-Crossover). This report assesses changes in psychosocial outcomes for all groups over 52 weeks.
CGM + FBI (n = 45), Standard-CGM (n = 42) and BGM-Crossover (n = 44) participants completed psychosocial assessments at baseline, 26 weeks and 52 weeks. Repeated measures linear regression models evaluated change within and between treatment groups.
The BGM-Crossover group reported improved diabetes burden (Δ -6.9, 95% CI [-11.3, -2.6], p = 0.003), fear of hypoglycaemia (Δ -6.4, CI [-10.1, -2.6], p = 0.002) and technology satisfaction (Δ 7.3, CI [2.4, 12.2], p = 0.005) from 26 to 52 weeks, similar to published findings in the CGM + FBI group over the first 26 weeks. The Standard-CGM group reported increased technology satisfaction (Δ 7.3, CI [0.6, 14.0], p = 0.027) from baseline to 52 weeks. The CGM + FBI group reported less diabetes burden and fear of hypoglycaemia from baseline to 52 weeks, but changes were not statistically significant. Scores from 26 to 52 weeks did not deteriorate.
Parents demonstrated psychosocial benefits following FBI that appeared to maintain without additional intervention. CGM-focused education with behavioural support likely helps parents of young children with type 1 diabetes reduce burden and worry in the short- and long-term.
管理儿童期 1 型糖尿病可能会给父母带来巨大压力。连续血糖监测（CGM）可能会减轻父母的负担。“通过强化策略增强儿童期 CGM 使用（SENCE）”试验将年龄在 2 至＜8 岁的 1 型糖尿病患儿的父母随机分配至 CGM 联合家庭行为干预（CGM+FBI）组、CGM 单独使用（标准-CGM）组或 CGM 之前接受 26 周血糖监测+FBI（BGM-交叉）组。本报告评估了所有组在 52 周内的社会心理结局变化。
CGM+FBI（n=45）、标准-CGM（n=42）和 BGM-交叉（n=44）组参与者在基线、26 周和 52 周时完成社会心理评估。重复测量线性回归模型评估治疗组内和组间的变化。
BGM-交叉组报告称，与 26 周相比，从 26 周到 52 周，糖尿病负担（Δ-6.9，95%CI[-11.3，-2.6]，p=0.003）、对低血糖的恐惧（Δ-6.4，CI[-10.1，-2.6]，p=0.002）和技术满意度（Δ7.3，CI[2.4，12.2]，p=0.005）有所改善，与 CGM+FBI 组在前 26 周的研究结果相似。标准-CGM 组从基线到 52 周时报告的技术满意度（Δ7.3，CI[0.6，14.0]，p=0.027）增加。CGM+FBI 组从基线到 52 周时报告糖尿病负担和对低血糖的恐惧有所减轻，但变化无统计学意义。从 26 周到 52 周的评分没有恶化。
接受 FBI 治疗的父母表现出社会心理获益，而且似乎无需额外干预即可维持获益。针对 CGM 的强化教育与行为支持可能有助于 1 型糖尿病患儿的父母在短期和长期减轻负担和担忧。
