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Pediatric Type 1 Diabetes: Patients' and Caregivers' Perceptions of Glycemic Control

Published:August 23, 2017DOI:https://doi.org/10.1016/j.jcjd.2017.07.002

      Abstract

      Objectives

      (1) to describe pediatric patients with T1D and their caregivers' perceptions of measures of glycemic control (hemoglobin [A1C] and blood glucose [BG] levels) and (2) to determine the relationship between patients' and caregivers' perceptions of measures of glycemic control with actual A1C levels and adherence to diabetes self-care behaviors.

      Methods

      Patients (8 to 18 years) with T1D and caregivers completed questionnaires that queried their perceptions of (1) what the A1C level assesses, (2) the ideal A1C target, and (3) the ideal BG range. Point-of-care A1C levels were measured for each patient. They also completed the Self-Care Inventory Revised (SCI-R) to assess adherence to diabetes self-care behaviors.

      Results

      Among 253 dyads, the frequencies of patients compared to caregivers who could accurately describe what the A1C level assesses, identify the ideal A1C target, and identify the ideal BG range were 20 vs. 66, 31 vs. 56, and 72 vs. 76%, respectively. Patients' accuracy in reporting ideal targets for glycemic control was significantly associated with caregivers' accuracy. There was a trend for lower median A1C levels in patients who were part of a dyad wherein both had accurate perceptions of glycemic control.

      Conclusions

      Patients and caregivers had accurate knowledge of ideal BG range but were less knowledgeable about the meaning of A1C levels and ideal A1C targets. Nevertheless, whether glycemic control was perceived as an A1C measurement or a BG range, A1C levels trended lower for patients when both they and their caregivers had accurate perceptions of glycemic control.

      Résumé

      Objectifs

      1) Décrire la perception des enfants et des adolescents atteints du DT1 et de leurs soignants sur les mesures liées à la régulation glycémique (les concentrations de l'hémoglobine [A1c] et de la glycémie [G]) ; 2) Déterminer la relation entre la perception des patients et des soignants sur les mesures liées à la régulation glycémique par rapport aux concentrations actuelles de l'A1c et à l'observance aux autosoins diabétiques.

      Méthodes

      Les patients (de 8 à 18 ans) atteints du DT1 et les soignants ont rempli les questionnaires qui visaient à connaître leur perception sur : 1) ce qu'évalue la concentration de l'A1c ; 2) la valeur cible idéalede l'A1c ; 3) la fourchette de G idéale. Les concentrations hors laboratoire de l'A1c de chacun des patients ont été mesurées. Ils ont également rempli la version révisée de l'Inventaire des capacités à prendre soin de sa personne (SCI-R, de l'anglais Self-Care Inventory Revised) pour évaluer l'observance aux autosoins diabétiques.

      Résultats

      Parmi les 253 dyades, les fréquences des patients par rapport à celles des soignants qui pourraient décrire avec exactitude ce qu'évalue la concentration de l'A1c, déterminer la valeur cible idéale de l'A1c et déterminer la fourchette de G idéale étaient respectivement de : 20 % vs 66 %, 31 % vs 56 % et 72 % vs 76 %. L'exactitude des patients à rapporter les valeurs cibles idéales de la régulation glycémique était significativement associée à l'exactitude des soignants. Il existait une tendance à des concentrations médianes d'A1c plus faibles chez les patients qui faisaient partie d'une dyade où les deux avaient des perceptions justes sur la régulation glycémique.

      Conclusions

      Les patients et les soignants possédaient des connaissances précises sur la fourchette de G, mais en possédaient moins sur la signification des concentrations d'A1c et des valeurs cibles idéales de l'A1c. Néanmoins, que la régulation glycémique soit considérée comme une mesure de l'A1c ou une fourchette de G, les concentrations d'A1c montraient une tendance à la baisse chez les patients lorsque ces derniers et leurs soignants avaient des perceptions justes de la régulation de la glycémie.

      Keywords

      Mots clés

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