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Cited by 30Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Feasibility of Electronic Health Record Assessment of 6 Pediatric Type 1 Diabetes Self-management Habits and Their Association With Glycemic Outcomes

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Lee, Joyce M., Rusnak, Andrea, Garrity, Ashley, Hirschfeld, Emily, Thomas, Inas H., Wichorek, Michelle, Lee, Jung Eun, Rioles, Nicole A. +2 more·2021·JAMA Network Open
DOI 10.1001/jamanetworkopen.2021.31278PMC PMC8554640
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Abstract

Importance: A low-burden electronic health record (EHR) workflow has been devised to systematize the collection and validation of 6 key diabetes self-management habits: (1) checks glucose at least 4 times/day or uses continuous glucose monitor (CGM); (2) gives at least 3 rapid-acting insulin boluses per day; (3) uses insulin pump; (4) delivers boluses before meals; (5) reviewed glucose data since last clinic visit, and (6) has changed insulin doses since the last clinic visit. Objective: To describe the performance of these habits and examine their association with hemoglobin A1c (HbA1c) levels and time in range (TIR). Design, Setting, and Participants: This cross-sectional study included individuals with known type 1 diabetes who were seen in a US pediatric diabetes clinic in 2019. Main Outcomes and Measures: Habit performance, total habit score (sum of 6 habits per person), HbA1c levels, and TIR. Results: Of 1344 patients, 1212 (609 [50.2%] males; 66 [5.4%] non-Hispanic Black; 1030 [85.0%] non-Hispanic White; mean [SD] age, 15.5 [4.5] years) were included, of whom 654 (54.0%) were using CGM and had a TIR. Only 105 patients (8.7%) performed all 6 habits. Habit performance was lower among older vs younger patients (age ≥18 years vs ≤12 years: 17 of 411 [4.1%] vs 57 of 330 [17.3%]; P < .001), Black vs White patients (3 [4.5%] vs 95 [9.2%]; P < .001), those with public vs private insurance (14 of 271 [5.2%] vs 91 of 941 [9.7%]; P < .001), and those with lower vs higher parental education levels (<college degree vs ≥college degree: 35 of 443 [7.9%] vs 66 of 574 [11.5%]; P < .001). After adjustment for demographic characteristics and disease duration, for every 1-unit increase in total habit score, we found a mean (SE) 0.6% (0.05) decrease in HbA1c among all participants and a mean (SE) 2.86% (0.71) increase in TIR among those who used CGMs. Multiple regression models revealed that performing each habit was associated with a significantly lower HbA1c level (habit 1: -0.16% [95% CI, -1.91% to -1.37%]; habit 2: -1.01% [-1.34% to -0.69%]; habit 3: -0.71% [95% CI, -0.93% to -0.49%]; habit 4: -0.97% [95% CI, -1.21% to -0.73%]; habit 5: -0.44% [95% CI, -0.71% to -0.17%]; habit 6: -0.75% [95% CI, -0.96% to -0.53%]; all P < .001). There were differences in HbA1c according to race, insurance, and parental education, but these associations were attenuated with the inclusion of the 6 habits, which had more robust associations with HbA1c levels than the demographic characteristics. Conclusions and Relevance: These findings suggest that a focus on increasing adherence to the 6 habits could be critical for improving disparities in glycemic outcomes; these metrics have been adopted by the Type 1 Diabetes Exchange Quality Improvement Collaborative for continuous quality improvement.

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  • A study of pediatric individuals with T1D identified six habits associated with reduction of HbA1c, four of which are related to insulin delivery.

    “A study of pediatric individuals with T1D identified six habits associated with reduction of HbA1c.28 Four of these six habits are related to insulin delivery, demonstrating the importance of ensuring that individuals with diabetes have the support they need to manage the complexity of determining when to deliver an insulin dose and how much insulin is needed.”

    From Shining the Spotlight on Multiple Daily Insulin Therapy: Real-World Evidence of the InPen Smart Insulin Pen (2024) · cites this paper as [28]

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Research works printed but not linked: 1

  1. [6]Ebekozien O, Noor N, Seyoum B,. Factors associated with optimal glycemic control in children and adolescents with type 1 diabetes: real world U.S. multicenter study. Poster presented at: American Diabetes Association’s 81st Scientific Sessions; June 25-29, 2021; virtual conference.

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Authors
Lee, J. M., Rusnak, A., Garrity, A., Hirschfeld, E., Thomas, I. H., Wichorek, M., Lee, J. E., Rioles, N. A., Ebekozien, O., & Corathers, S. D.
Affiliations
  • University of Michigan (US)
  • T1D Exchange (US)
  • Cincinnati Children's Hospital Medical Center (US)
Corresponding author
Lee, Joyce M.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2021-10-28
Volume
4
Issue
10
Pages
e2131278
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2021.31278
PMC
PMC8554640
OpenAlex
W3208553348
Cited by
30
References
29
Citations by year
2025: 7 · 2024: 8 · 2023: 11 · 2022: 3 · 2021: 1
FWCI
4.29
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926, P30DK020572)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes in children, diabetes self-management, continuous glucose monitoring, insulin pump, glycemic control, HbA1c, time in range, racial disparities, insurance status, parental education, adolescents and young adults, diabetes self-management education
MeSH terms
Self-Management, Glycemic Control, Adolescent, Child, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Feasibility Studies, Female, Humans, Hypoglycemia, Male, Young Adult, Electronic Health Records

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