CGM Education, Family Behavioral Intervention May Help Reduce Burden on Parents of Children With T1D

Continuous glucose monitoring (CGM)-focused education in addition to behavioral support likely helps parents of young children with type 1 diabetes (T1D) reduce burden and worry in both the short- and long-term, new research suggests.

Writing in the journal Diabetic Medicine, authors explained parents demonstrated psychosocial benefits following family behavioral intervention (FBI) that appeared to continue without any additional intervention.

The significant social, physical and emotional development that occurs before age 8 poses a challenge for managing T1D in these young patients. Challenges can include rapid growth, variable insulin needs, and unpredictable eating and physical activity.

“Managing this demanding regimen in young children can be burdensomeand is associated with substantial parental emotionaldistress,” authors wrote.

To better enhance glycemic and psychosocial benefits of CGM in young children and their parents, researchers carried out the Strategies to Enhance CGM use in Early Childhood (SENCE) study between 2016 and 2019.

The longitudinal, multisite, randomized controlled trial compared CGM with education alone, CGM with education and afamily behavioral intervention for parents (CGM+FBI), and blood glucose monitoring alone without CGM or FBI (BGM), researchers explained.

The current analysis includes 12-month psychosocial outcomes from the study’s 3 groups.

A total of 45 children were enrolled in the CGM+FBI group, 42 in the standard CGM group, 44 in the BGM crossover group. These participants completed psychosocial assessments at baseline, 26 weeks and 52 weeks.

The FBI included 5 behavioral intervention sessions delivered by trained, non-medical study staff and provided education and support targeting common challenges parents face when it comes to diabetes technologies. The sessions took place in-person or via telephone depending on the site’s location.

Data showed:

• The BGM-Crossover group reported improved diabetes burden (Δ −6.9; 95% CI, −11.3 to −2.6; P = .003), fear of hypoglycemia (Δ −6.4; 95% CI, −10.1 to −2.6; P = .002) and technology satisfaction (Δ 7.3; 95% CI, 2.4 to 12.2; P = .005) from 26 to 52 weeks, similar to published findings in the CGM+FBI group over the first 26 weeks
• The Standard-CGM group reported increased technology satisfaction (Δ 7.3; 95% CI, 0.6 to 14.0; P = .027) from baseline to 52 weeks
• The CGM+FBI group reported less diabetes burden and fear of hypoglycemia from baseline to 52 weeks, but changes were not statistically significant. Scores from 26 to 52 weeks did not deteriorate.  

Overall, “the trial demonstrated multiple psychosocialbenefits of this intervention approach, with patterns of responses over 1 year suggesting lasting positive effects,” authors wrote.

Though they were not statistically significant, psychosocial outcomes indicated modest improvements at 52 weeks. In addition, lack of deterioration in burden and fear of hypoglycemia scores between the 2 study points suggests the FBI’s positive effects continued past the intervention phase.

The study population used Dexcom G5 and perceptions of burdens may not translate to users’ experiences with newer CGM models, marking a limitation. The sample was also not adequately powered to identify any potential predictors of psychosocial change.

“Future iterations of the intervention may beneeded to address novel challenges and burdens related totechnology use as CGM features continue to advance andhybrid closed-loop systems become more widely available,” researchers concluded.

“Additional attention to the use, benefits and challenges ofremote monitoring is also warranted. The results of thecurrent study are promising in facilitating adjustmentand satisfaction with CGMtechnology in parents of veryyoung children,” they added.

Reference

Commissariat PV, DiMeglio LA, Kanapka LG, et al. Twelve-month psychosocial outcomes of continuous glucose monitoring with behavioural support in parents of young children with type 1 diabetes. Diabet Med. Published online April 19, 2023. doi:10.1111/dme.15120