Exploring factors influencing HbA1c and psychosocial outcomes in people with type 1 diabetes after training in advanced carbohydrate counting

TY - JOUR

T1 - Exploring factors influencing HbA1c and psychosocial outcomes in people with type 1 diabetes after training in advanced carbohydrate counting

AU - Schmidt, Signe

AU - Vistisen, Dorte

AU - Almdal, Thomas

AU - Hommel, Eva

AU - Nørgaard, Kirsten

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017/8

Y1 - 2017/8

N2 - Aims The purpose of this secondary analysis of the StenoABC Study was to identify determinants of the changes in HbA1c observed after training of people with type 1 diabetes in advanced carbohydrate counting (ACC) and automated bolus calculator (ABC) use, and further to investigate psychosocial effects of these insulin dosing approaches. Methods Validated diabetes-specific questionnaires were used to assess diabetes treatment satisfaction, problem areas in diabetes, fear of hypoglycemia and diabetes dependent quality of life before and one year after the training. In addition, numeracy was tested (using a non-validated test developed specifically for this study) and behavioral measures (number of daily blood glucose measurements and self-reported use of ACC) were obtained. Associations between change in HbA1c and these measures plus sex, age, diabetes duration and BMI were tested. Results Numeracy was the only baseline predictor of yearly change in HbA1c identified. Higher levels of numeracy were associated with greater reductions in HbA1c (P = 0.031). No associations between change in HbA1c and the behavioral measures investigated were found, nor were any clinically relevant associations between changes in HbA1c and questionnaire scores. Treatment satisfaction increased in all users of ACC (P < 0.001). People who also used an ABC reported significantly lower levels of fear of hypoglycemia than people who practiced ACC without such device (P = 0.005). Conclusions Improvements in HbA1c after training in ACC were inversely related to numeracy. Use of an ABC did not compensate for poor numeracy skills. However, device use reduced fear of hypoglycemia compared with ACC without ABC use.

AB - Aims The purpose of this secondary analysis of the StenoABC Study was to identify determinants of the changes in HbA1c observed after training of people with type 1 diabetes in advanced carbohydrate counting (ACC) and automated bolus calculator (ABC) use, and further to investigate psychosocial effects of these insulin dosing approaches. Methods Validated diabetes-specific questionnaires were used to assess diabetes treatment satisfaction, problem areas in diabetes, fear of hypoglycemia and diabetes dependent quality of life before and one year after the training. In addition, numeracy was tested (using a non-validated test developed specifically for this study) and behavioral measures (number of daily blood glucose measurements and self-reported use of ACC) were obtained. Associations between change in HbA1c and these measures plus sex, age, diabetes duration and BMI were tested. Results Numeracy was the only baseline predictor of yearly change in HbA1c identified. Higher levels of numeracy were associated with greater reductions in HbA1c (P = 0.031). No associations between change in HbA1c and the behavioral measures investigated were found, nor were any clinically relevant associations between changes in HbA1c and questionnaire scores. Treatment satisfaction increased in all users of ACC (P < 0.001). People who also used an ABC reported significantly lower levels of fear of hypoglycemia than people who practiced ACC without such device (P = 0.005). Conclusions Improvements in HbA1c after training in ACC were inversely related to numeracy. Use of an ABC did not compensate for poor numeracy skills. However, device use reduced fear of hypoglycemia compared with ACC without ABC use.

KW - Adult

KW - Biomarkers/blood

KW - Diabetes Mellitus, Type 1/blood

KW - Diet

KW - Dietary Carbohydrates/metabolism

KW - Fear

KW - Female

KW - Glycated Hemoglobin A/metabolism

KW - Humans

KW - Hypoglycemia/blood

KW - Hypoglycemic Agents/therapeutic use

KW - Insulin/therapeutic use

KW - Male

KW - Mathematical Concepts

KW - Middle Aged

KW - Quality of Life

KW - Randomized Controlled Trials as Topic

KW - Surveys and Questionnaires

U2 - 10.1016/j.diabres.2017.05.021

DO - 10.1016/j.diabres.2017.05.021

M3 - Journal article

C2 - 28570925

SN - 0168-8227

VL - 130

SP - 61

EP - 66

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

ER -