Dilek Semine Ozdemir, Çömlek Fatma Özgüç
Department of Pediatric Endocrinology, Adana City Training and Research Hospital, Adana 01370, Turkey.
Department of Pediatric Endocrinology, Medical Faculty, Selçuk University, Konya 42250, Turkey.
Children (Basel). 2025 Apr 3;12(4):463. doi: 10.3390/children12040463.
This study sought to identify key barriers to treatment adherence in children and adolescents with type 1 diabetes (T1D) using the Adherence Starts with Knowledge-12 (ASK-12) questionnaire and to evaluate its impact on metabolic control, providing insights for optimizing T1D management. A total of 160 children and adolescents with T1D aged 5-18 years who sought treatment from a pediatric endocrinology outpatient clinic between June and August in 2022 were prospectively examined. The patients' low treatment adherence (LTA) or high treatment adherence (HTA) was determined based on their ASK-12 questionnaire scores. Two pediatric endocrinologists reviewed the participants' medical records and then classified them into two groups: tight metabolic control and poor metabolic control. LTA, which was determined based on the participants' ASK-12 scores, was significantly associated with puberty, presence of diabetic ketoacidosis, and daily self-management ( < 0.001, < 0.001, and < 0.001, respectively). Those whose ASK-12 scores indicated LTA were older and had a longer duration of T1D, higher hemoglobin A1c levels, and lower BMI-SDS values than those with HTA) ( < 0.001, < 0.001, < 0.001, and < 0.001, respectively). A total of 94 (59%) participants were indicated to have HTA, but 24 (25.5%) of them were found by the clinicians to have poor metabolic control. The ASK-12 questionnaire scores can identify pediatric patients with T1D who exhibit LTA and thus may be beneficial for early recognition of low adherence. Approximately 25% of the patients with ASK-12 scores indicating HTA were at risk of poor metabolic control. Puberty, duration of T1D, BMI-SDS, HbA1C, and parental involvement alongside ASK-12 score may be considered to improve treatment compliance. Integrating these variables into adherence assessments may enhance treatment compliance and improve long-term outcomes in pediatric T1D management.
本研究旨在使用“依从性始于知识 - 12”（ASK - 12）问卷确定1型糖尿病（T1D）儿童和青少年治疗依从性的关键障碍，并评估其对代谢控制的影响，为优化T1D管理提供见解。对2022年6月至8月期间在儿科内分泌门诊寻求治疗的160名5 - 18岁T1D儿童和青少年进行了前瞻性检查。根据患者的ASK - 12问卷得分确定其低治疗依从性（LTA）或高治疗依从性（HTA）。两位儿科内分泌学家查阅了参与者的病历，然后将他们分为两组：代谢控制良好和代谢控制不佳。基于参与者的ASK - 12得分确定的LTA与青春期、糖尿病酮症酸中毒的存在以及日常自我管理显著相关（分别为P < 0.001、P < 0.001和P < 0.001）。ASK - 12得分表明为LTA的患者比HTA患者年龄更大、T1D病程更长、糖化血红蛋白水平更高且BMI - SDS值更低（分别为P < 0.001、P < 0.001、P < 0.001和P < 0.001）。共有94名（59%）参与者被表明具有HTA，但临床医生发现其中24名（25.5%）代谢控制不佳。ASK - 12问卷得分可以识别出表现出LTA的T1D儿科患者，因此可能有助于早期识别低依从性。ASK - 12得分表明为HTA的患者中约25%有代谢控制不佳的风险。青春期、T1D病程、BMI - SDS、糖化血红蛋白以及家长参与度连同ASK - 12得分可被考虑用于改善治疗依从性。将这些变量纳入依从性评估可能会提高治疗依从性并改善儿科T1D管理的长期结果。
