Study evaluates system for pediatric T1D management compliance

Compliance with just about everything can be difficult to achieve during the teen years. For adolescents with type 1 diabetes (T1D), though, noncompliance can be life-threatening.

To help teens with the difficult emotional and physical weight of managing this disease, numerous tools, technology platforms, and interventions have been developed. A research team recently published a review of one of these tools, a 40-year-old automated messaging system.

Published in Diabetes Therapy, the 2023 study followed dozens of parents and teens managing T1D over a 12-month period. The research team used a decision support system (DSS) called CloudConnect that offeres teens and their caregivers weekly, automated advice specific to their T1D management.

The goal of the project was to see whether the automated platform could facilitate improved shared responsibility between teens with T1D and their parents and lead to improved glycemic control.

The study group consisted of nearly 90 participants, including more than 40 T1D teens that weren’t on automated insulin delivery systems. The intervention program was compared to traditional care models for teens with T1D, it provided weekly T1D management advice like insulin dose adjustments using data gleaned from continuous glucose monitors and personal health devices. The hope was that these reports could be used to help improve communication specific to T1D management, hemoglobin A1c, the amount of time spent in target glucose ranges, and other psychological aspects of the disease.

At the end of the study period, researchers found that the usual care group and the intervention group had similar HbA1c levels and time within blood glucose goal ranges, but both parents and teen reported little change in communication strategies. Parents in the CloudConnect group reported feeling less conflict over T1D-related issues with the use of the tool, but this sentiment was not shared by teens in the study. Additionally, parents and teens reported feeling a more negative tone overall in the CloudConnect group compared to the usual care group.

In terms of health outcomes, the research team found that there were more frequent changes of insulin dosing in the CloudConnect group, but no real change in overall quality of life measures.

Despite hope that CloudConnect could improve communication and ultimately outcomes for teens with T1D, the study team concluded that better tools are needed to improve disease management in adolescents who aren’t on automated insulin delivery systems.

Part of the difficulty in managing T1D in teens is the fact that teens desire more autonomy but also have unpredictable schedules, fluctuating insulin demands, and relationship pressures with peers and parents that could complicate compliance, according to the study report. It’s also a time when patients are transitioning from a time where caregivers manage their disease to more independent T1D control. This shifting of responsibility can lead to more conflict than usual between parents and teens, and more positive communication is usually associated with improved HbA1c values.

Ultimately, the research team found that the CloudConnect tool did little to improve outcomes in teens with T1D and may have made the tone of interactions on diabetes management more negative overall.

Mark D. DeBoer, MD, MSc, MCR, a pediatrics professor at the University of Virginia and one of the authors of the study, says perceptions of a negative tone weren’t all that surprising, and the results highlight how variable T1D communication between teens and their caregivers can be.

“The adolescents in the control group reported a decrease in frequency of communication from a score of 12.2 to 11.5, while the CloudConnect group had an increase from 12.0 to 12.3,” DeBoer said. “The difference was bigger for parents, where the control group went from 11 to 9, and the CloudConnect groups went from 11 to 12.”

Both trends moved in the direction the research team expected, said DeBoer, but the amount of variability on both sides made it difficult to prove statistical significance.

“This system was designed to bring parent-child dyads together to look at the facts about the blood sugar numbers,” he explained. But adolescence is a difficult time in diabetes control, and that it’s likely that the facts did not always line up the way the parents hoped.”

DeBoer said the results of the study highlight the high-tech tools aren’t a sure-fire answer to improving outcomes.

“Disease-related communication is still important, but that relying on a product to change or improve that communication is not a guarantee that you will improve the level of communication,” DeBoer said.

Reference:

De Boer MD, Valdez R, Corbett JP, et al. Effect of an Automated Advice Algorithm (CloudConnect) on Adolescent-Parent DiabetesSpecific Communication and Glycemic Management: A Randomized Trial. Diabetes Ther. February 2023;14:899-913. doi:10.1007/s13300-023-01401-9