Frequency of Mealtime Insulin Bolus as a Proxy Measure of Adherence for Children and Youths with Type 1 Diabetes Mellitus
Frequency of Mealtime Insulin Bolus as a Proxy Measure of Adherence for Children and Youths with Type 1 Diabetes Mellitus
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DOI：
10.1089/dia.2012.0229
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发表时间：
2013-02-01
影响因子：
5.4
通讯作者：
DeLurgio, Stephen A.
中科院分区：
文献类型：
--
作者：
Patton, Susana R.;Clements, Mark A.;DeLurgio, Stephen A.
背景：电子依从性测量可能优于患者报告。在1型糖尿病患者中，由患者的家用血糖仪测量的血糖监测(BGM)频率已被确定为依从性的有效替代指标。我们提出了使用胰岛素泵记录计算依从性的方法，并评估了该方法的可靠性和有效性。对象和方法：从100名1型糖尿病儿童和青年(平均+/-SD年龄，12.7+/-4.6岁)的临床和研究数据库中随机收集血糖仪数据、胰岛素泵记录和相应的HbA1c水平。计算青少年平均每日BGM频次。此外，我们还计算了平均进餐时间胰岛素推注得分(BOLUS)：年轻人在0600至1000小时、1100至1500小时、1600至2200小时(最大为1分/餐或3分/天)每次推注胰岛素1分。结果：年轻人的HbA1c水平、年龄、BGM频率和胰岛素推注分数之间的简单相关性均显著。偏相关分析和多元回归分析表明，与电子记录的每日血糖测量频率相比，胰岛素推注分数更能解释HbA1c水平的变化。结论：我们使用胰岛素泵记录计算胰岛素推注分数的方法与年轻人HbA1c水平的一致性比BGM频率与年轻人HbA1c水平的一致性更好。我们的分析表明，在预测年轻人的HbA1c水平方面，胰岛素推注评分优于BGM频率。
Background: Electronic measures of adherence can be superior to patient report. In type 1 diabetes, frequency of blood glucose monitoring (BGM), as measured by patients' home blood glucose meters, has already been identified as a valid proxy of adherence. We present methodology to calculate adherence using insulin pump records and evaluate the reliability and validity of this methodology.Subjects and Methods: Blood glucose meter data, insulin pump records, and corresponding hemoglobin A1c (HbA1c) levels were randomly gathered from clinical and research databases for 100 children and youths (referred to hereafter as youths) with type 1 diabetes (mean +/- SD age, 12.7 +/- 4.6 years). Youths' mean frequency of daily BGM was calculated. Additionally, we calculated a mean mealtime insulin bolus score (BOLUS): youths received 1 point each for a bolus between 0600 and 1000 h, 1100 and 1500 h, and 1600 and 2200 h (maximum of 1 point/meal or 3 points/day).Results: Simple correlations between youths' HbA1c level, age, frequency of BGM, and insulin BOLUS scores were all significant. Partial correlations and multiple regression analyses revealed that insulin BOLUS scores better explain variations in HbA1c levels than the electronically recorded frequency of daily blood glucose measures.Conclusions: Our procedures for calculating insulin BOLUS scores using insulin pump records demonstrate better concurrent validity with youths' HbA1c levels than that of the frequency of BGM with youths' HbA1c levels. Our analyses have shown that insulin bolus scoring was superior to the frequency of BGM in predicting youths' HbA1c levels.