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Association Between Adherence and Glycemic Control in Pediatric Type 1 Diabetes: A Meta-analysis
Abstract
CONTEXT: Although adherence has been identified in practice guidelines for youth with type 1 diabetes to promote optimal glycemic control, there has been no systematic integration of studies investigating the adherence-glycemic control link. This recommendation partly stemmed from the Diabetes Control and Complications Trial (DCCT); however, this trial did not comprehensively measure adherence and had only 195 adolescents. OBJECTIVE: Our goal was to determine the magnitude of the adherence-glycemic control link in pediatric type 1 diabetes and evaluate its correlates. METHODS: Our data sources were PubMed (1950–2008), Scopus (1950–2008), and references from reviews in pediatric type 1 diabetes. Studies that included youth under age 19 with type 1 diabetes and a reported association between adherence and glycemic control were eligible for inclusion. Articles were not included if they contained youth with type 2 diabetes, had study samples that overlapped with other studies, or the results came from intervention studies. Of the eligible 26 studies, 21 had sufficient statistical data. Two authors independently extracted information by using a standardized protocol. Agreement between coders was high. RESULTS: The mean effect size across 21 studies, including 2492 youth with type 1 diabetes, was −0.28 (95% confidence interval: −0.32 to −0.24). As adherence increases, A1c values decrease. No sample or disease characteristics were correlates of the adherence-glycemic control link. Pre-DCCT studies had a mean effect size of −0.32 (8 studies; 1169 participants) compared with −0.25 in post-DCCT studies (13 studies; 1323 participants). CONCLUSIONS: This meta-analysis supports the adherence-glycemic control link in pediatric type 1 diabetes. The weaker post-DCCT association suggests that the approach to intensive diabetes management has shortcomings. We conclude that this is because of a mismatch between what scientists and clinicians know is the best way to manage pediatric type 1 diabetes and the capabilities of youth and their families.
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“While following treatment regimens consistently improves A1C (9–12), the impact is modest.”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [10]
In the citing paper
“The impact of missed insulin injections on HbA1c levels is well established,7–12 leading to an increasing risk of diabetes-related complications.13,14”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [9]
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“Given associations with glycemic outcomes and risk for future complications (298,299)”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [298]
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Trojanowski, P. J., Pardon, A., Reynolds, C. M., O’Donnell, H. K., Alonso, G. T., Majidi, S., Snell‐Bergeon, J. K., Wadwa, R. P., & Driscoll, K. A. (2024) · Diabetic Medicine · doi:10.1111/dme.15325 · Cited by 1
School performance among diabetic Children and adolescents
Jlab, A. K., & Hasan, A. S. (2019) · AL-QADISIYAH MEDICAL JOURNAL · doi:10.28922/qmj.2019.15.1.61-75 · Cited by 2
Costs and economic impacts of type-1 diabetes from the Dominican patient perspective
Martinez, A. G., Peña, C. N. V., Almonte, D. C., Castro, N. E. R., Colón-Arias, F., & Gresse, S. (2021) · Principles and Practice of Clinical Research Journal · doi:10.21801/ppcrj.2021.72.1 · Cited by 1
Ambler, G. R., Cameron, F. J., Joshi, K., & Wherrett, D. K. (2019) · Wiley eBooks · doi:10.1002/9781119152712.ch15 · Cited by 1
Understanding and quantifying adherence and its link to therapeutic success
Assawasuwannakit, P. (2015) · Otago University Research Archive (University of Otago)
Metadata
- Authors
- Hood, K. K., Peterson, C. M., Rohan, J. M., & Drotar, D.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2009-12-01
- Volume
- 124
- Issue
- 6
- Pages
- e1171-e1179
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2000449651
- Cited by
- 347
- References
- 64
- Citations by year
- 2026: 15 · 2025: 7 · 2024: 10 · 2023: 14 · 2022: 18 · 2021: 18 · 2020: 24 · 2019: 22 · 2018: 22 · 2017: 25 · 2016: 29 · 2015: 26 · 2014: 25 · 2013: 27 · 2012: 32
- FWCI
- 2.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK073340)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- type 1 diabetes in children, medication adherence, glycemic control, HbA1c, adolescents, intensive diabetes management, Diabetes Control and Complications Trial
- MeSH terms
- Adolescent, Child, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin, Humans, Male, Patient Compliance, Blood Glucose Self-Monitoring, Treatment Outcome
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